Provider Demographics
NPI:1437355674
Name:JASPER, JOE
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:
Last Name:JASPER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:JASPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:136 MAIN ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-5422
Mailing Address - Country:US
Mailing Address - Phone:847-905-0042
Mailing Address - Fax:
Practice Address - Street 1:136 MAIN ST
Practice Address - Street 2:UNIT B
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-5422
Practice Address - Country:US
Practice Address - Phone:847-905-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor