Provider Demographics
NPI:1215124227
Name:JKT ENTERPRISES INC.
Entity type:Organization
Organization Name:JKT ENTERPRISES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:MR
Authorized Official - First Name:ALOK
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIVEDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-854-5356
Mailing Address - Street 1:43 WEST ACORN LANE
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-4804
Mailing Address - Country:US
Mailing Address - Phone:847-854-5356
Mailing Address - Fax:847-854-5436
Practice Address - Street 1:43 W ACORN LN
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-4804
Practice Address - Country:US
Practice Address - Phone:847-854-5356
Practice Address - Fax:847-854-5436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JKT ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-03
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009757302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212319Medicare PIN