Provider Demographics
NPI:1073554135
Name:PATEL, NIRAV S (DC)
Entity Type:Individual
Prefix:MR
First Name:NIRAV
Middle Name:S
Last Name:PATEL
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 1:4 INDUSTRIAL BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301
Mailing Address - Country:US
Mailing Address - Phone:610-644-3166
Mailing Address - Fax:610-644-3162
Practice Address - Street 1:4 INDUSTRIAL BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-644-3166
Practice Address - Fax:610-644-3162
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2234146000OtherIBC NETWORK
PA001559591OtherBCBS HIGHMARK
PA7781521OtherAETNA
PA096434Medicare PIN
PA2234146000OtherIBC NETWORK