Provider Demographics
NPI:1235413170
Name:PATEL, JASMINA (DC)
Entity Type:Individual
Prefix:
First Name:JASMINA
Middle Name:
Last Name:PATEL
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:PO BOX 5977
Mailing Address - Street 2:DEPT 20-3005
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5977
Mailing Address - Country:US
Mailing Address - Phone:630-754-8788
Mailing Address - Fax:630-754-8792
Practice Address - Street 1:175 W JACKSON BLVD
Practice Address - Street 2:STE. 2150
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-2615
Practice Address - Country:US
Practice Address - Phone:312-262-6224
Practice Address - Fax:312-262-6227
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-012036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor