Provider Demographics
NPI:1083924641
Name:SHAH, PREETY PRATIK (DC)
Entity Type:Individual
Prefix:DR
First Name:PREETY
Middle Name:PRATIK
Last Name:SHAH
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 1:1736 ARIANA DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-2314
Mailing Address - Country:US
Mailing Address - Phone:630-456-0640
Mailing Address - Fax:
Practice Address - Street 1:1736 ARIANA DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-2314
Practice Address - Country:US
Practice Address - Phone:630-456-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011715111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist