Provider Demographics
NPI:1578615613
Name:KAAPKE, JASON ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALLEN
Last Name:KAAPKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15930 75TH CT
Mailing Address - Street 2:STE 200
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1325
Mailing Address - Country:US
Mailing Address - Phone:708-532-2226
Mailing Address - Fax:708-845-5478
Practice Address - Street 1:15930 75TH CT
Practice Address - Street 2:STE 200
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1325
Practice Address - Country:US
Practice Address - Phone:708-532-2226
Practice Address - Fax:708-845-5478
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634829OtherBCBS
U99962Medicare UPIN
IL209132Medicare ID - Type Unspecified