MEDICARE: DR. KRISHAN NADARAJAH D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038013339	IL

General Provider Information

NPI Number	:	1699383075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISHAN NADARAJAH D.C.

Provider Business Mailing Address
First Line	:	16617 KINGSBROOK DR
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60403-0713
Country	:	US
Telephone Number	:	815-274-7457
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 W LAKE ST STE 103
Second Line	:
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-1027
Country	:	US
Telephone Number	:	630-351-0222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2020
Last Update Date	:	07/21/2020

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