Provider Demographics
NPI:1568548857
Name:D'SOUZA, MEVIN J (DC)
Entity Type:Individual
Prefix:DR
First Name:MEVIN
Middle Name:J
Last Name:D'SOUZA
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 1:804 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-5829
Mailing Address - Country:US
Mailing Address - Phone:312-842-2447
Mailing Address - Fax:312-873-3772
Practice Address - Street 1:804 W 31ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-5829
Practice Address - Country:US
Practice Address - Phone:312-842-2447
Practice Address - Fax:312-873-3772
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01606186Medicare ID - Type Unspecified
ILU51259Medicare UPIN