Provider Demographics
NPI:1184684524
Name:BASALA, PATRICIA GERLEMAN (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:GERLEMAN
Last Name:BASALA
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 1:504 1ST STREET WEST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-2716
Mailing Address - Country:US
Mailing Address - Phone:309-787-4944
Mailing Address - Fax:309-787-9440
Practice Address - Street 1:504 1ST STREET WEST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-2716
Practice Address - Country:US
Practice Address - Phone:309-787-4944
Practice Address - Fax:309-787-9440
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0008182013OtherBLUE CROSS BLUE SHIELD
IL0008182013OtherBLUE CROSS BLUE SHIELD
U50546Medicare UPIN