Provider Demographics
NPI:1407998149
Name:PATEL, KANAK D (DC)
Entity Type:Individual
Prefix:DR
First Name:KANAK
Middle Name:D
Last Name:PATEL
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 1:16420 PERRIS BLVD STE Q
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-1136
Mailing Address - Country:US
Mailing Address - Phone:951-571-2450
Mailing Address - Fax:951-571-2455
Practice Address - Street 1:16420 PERRIS BLVD STE Q
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-1136
Practice Address - Country:US
Practice Address - Phone:951-571-2450
Practice Address - Fax:951-571-2455
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor