Provider Demographics
NPI:1790038644
Name:WASSON, JILLIAN (DC)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:WASSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 APPLE GROVE LN
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-3455
Mailing Address - Country:US
Mailing Address - Phone:419-320-4100
Mailing Address - Fax:
Practice Address - Street 1:5509 BELMONT RD
Practice Address - Street 2:1D
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4473
Practice Address - Country:US
Practice Address - Phone:630-960-3969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor