Provider Demographics
NPI:1932420510
Name:DELLINGER, JADE ASHLEY (DC)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ASHLEY
Last Name:DELLINGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:ASHLEYU
Other - Last Name:LEASURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:112 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1812
Mailing Address - Country:US
Mailing Address - Phone:847-362-4476
Mailing Address - Fax:847-367-5339
Practice Address - Street 1:112 W LAKE ST
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1812
Practice Address - Country:US
Practice Address - Phone:847-362-4476
Practice Address - Fax:847-367-5339
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor