Provider Demographics
NPI:1104863984
Name:DOROSHEFF, PAUL EVANS (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EVANS
Last Name:DOROSHEFF
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 1:26499 WOHLER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:62642-9574
Mailing Address - Country:US
Mailing Address - Phone:314-471-8212
Mailing Address - Fax:618-337-7109
Practice Address - Street 1:1518 CAMP JACKSON RD
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-2561
Practice Address - Country:US
Practice Address - Phone:314-471-8212
Practice Address - Fax:618-337-7109
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician