Provider Demographics
NPI:1134297740
Name:JAIN, DHANPAL H
Entity Type:Individual
Prefix:MR
First Name:DHANPAL
Middle Name:H
Last Name:JAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3423
Mailing Address - Country:US
Mailing Address - Phone:847-677-4214
Mailing Address - Fax:
Practice Address - Street 1:6850 LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3423
Practice Address - Country:US
Practice Address - Phone:847-677-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212575Medicare ID - Type Unspecified