=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841103298
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXTGEN CHIROPRACTIC MEDICAL GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2026
-----------------------------------------------------
Last Update Date | 09/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4735 LILAC AVE
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60025-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-542-1111
-----------------------------------------------------
Fax | 773-542-7100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4735 LILAC AVE
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60025-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-542-1111
-----------------------------------------------------
Fax | 773-542-7100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MANISH M PANDYA
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 773-542-1111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------