Provider Demographics
NPI:1215287644
Name:PATEL, MINA HIRJI (DC, CCN)
Entity type:Individual
Prefix:DR
First Name:MINA
Middle Name:HIRJI
Last Name:PATEL
Suffix:
Gender:F
Credentials:DC, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N LINCOLN AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7170
Mailing Address - Country:US
Mailing Address - Phone:312-448-8122
Mailing Address - Fax:773-248-2058
Practice Address - Street 1:2202 N LINCOLN AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7170
Practice Address - Country:US
Practice Address - Phone:312-448-8122
Practice Address - Fax:773-248-2058
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012243111NN1001X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NN1001XChiropractic ProvidersChiropractorNutrition