Provider Demographics
NPI:1679715544
Name:PURSLEY, JASON TIMOTHY (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:TIMOTHY
Last Name:PURSLEY
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 1:5225 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1401
Mailing Address - Country:US
Mailing Address - Phone:708-422-4440
Mailing Address - Fax:708-422-5444
Practice Address - Street 1:5225 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1401
Practice Address - Country:US
Practice Address - Phone:708-422-4440
Practice Address - Fax:708-422-5444
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor