Provider Demographics
NPI:1710110481
Name:LAMARCHE, JASON P (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:LAMARCHE
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 1:180 E. MAIN
Mailing Address - Street 2:
Mailing Address - City:BRAIDWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60408
Mailing Address - Country:US
Mailing Address - Phone:815-458-2225
Mailing Address - Fax:815-458-9825
Practice Address - Street 1:180 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRAIDWOOD
Practice Address - State:IL
Practice Address - Zip Code:60408-1912
Practice Address - Country:US
Practice Address - Phone:815-458-2225
Practice Address - Fax:815-458-9825
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor