Provider Demographics
NPI:1073582151
Name:PATEL, VIPUL R (DC)
Entity Type:Individual
Prefix:DR
First Name:VIPUL
Middle Name:R
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 1:6947 MERRILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2684
Mailing Address - Country:US
Mailing Address - Phone:904-743-2222
Mailing Address - Fax:904-743-3087
Practice Address - Street 1:6947 MERRILL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2684
Practice Address - Country:US
Practice Address - Phone:904-743-2222
Practice Address - Fax:904-743-3087
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350056717OtherMEDICARE RAILROAD
FL70147OtherBLUE CROSS/BLUESHIELD
FL381498000Medicaid
FL381498000Medicaid