Healthcare Provider Details

I. General information

NPI: 1467404772
Provider Name (Legal Business Name): SANJAY N PATEL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 E 10TH ST
JEFFERSONVILLE IN
47130-6016
US

IV. Provider business mailing address

2100 MARKET ST STE 101
CHARLESTOWN IN
47111-9535
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-2488
  • Fax: 812-288-6603
Mailing address:
  • Phone: 812-503-5100
  • Fax: 770-573-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5051
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number08002231A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002231A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: