Provider Demographics
NPI:1043275142
Name:KOMESHAK, PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:KOMESHAK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PARK PL STE B
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2965
Mailing Address - Country:US
Mailing Address - Phone:618-236-3600
Mailing Address - Fax:
Practice Address - Street 1:3 PARK PL STE B
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2965
Practice Address - Country:US
Practice Address - Phone:618-236-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08221308OtherBCBS ILLINOIS
U66933OtherMERCY
104259OtherGHP GROUP
375120OtherHEALTHLINK
IL038008047Medicaid
371371791OtherTRICARE
4400415OtherUHC
DD4196OtherMEDICARE RAILROAD GROUP
104260OtherGHP
7083136OtherAETNA
MO111586OtherBCBS MISSOURI
MO111586OtherBCBS MISSOURI
104259OtherGHP GROUP
375120OtherHEALTHLINK
ILK18673Medicare PIN