Provider Demographics
NPI:1467498022
Name:PANDYA, MANISH D (DC)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:D
Last Name:PANDYA
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 1:703 E FULLERTON AVE
Mailing Address - Street 2:UNIT 107
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2917
Mailing Address - Country:US
Mailing Address - Phone:630-965-2225
Mailing Address - Fax:
Practice Address - Street 1:4111 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4313
Practice Address - Country:US
Practice Address - Phone:773-542-1111
Practice Address - Fax:773-542-7100
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009513Medicaid
IL0001637989OtherBCBS
IL215869Medicare PIN