Healthcare Provider Details

I. General information

NPI: 1174595235
Provider Name (Legal Business Name): VIJAY PATEL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E EUCLID AVE STE 460
MT PROSPECT IL
60056-1287
US

IV. Provider business mailing address

55 E EUCLID AVE STE 460
MT PROSPECT IL
60056-1287
US

V. Phone/Fax

Practice location:
  • Phone: 847-222-9060
  • Fax: 847-222-9130
Mailing address:
  • Phone: 847-222-9060
  • Fax: 847-222-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008725
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: