Provider Demographics
NPI:1992823926
Name:PATEL, JIGNASA (DC)
Entity type:Individual
Prefix:DR
First Name:JIGNASA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 BURTON DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1300
Mailing Address - Country:US
Mailing Address - Phone:630-543-5454
Mailing Address - Fax:630-543-5471
Practice Address - Street 1:276 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3767
Practice Address - Country:US
Practice Address - Phone:630-543-5454
Practice Address - Fax:630-543-5471
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV02997Medicare UPIN