Provider Demographics
NPI:1699383075
Name:NADARAJAH, KRISHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISHAN
Middle Name:
Last Name:NADARAJAH
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 1:16617 KINGSBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0713
Mailing Address - Country:US
Mailing Address - Phone:815-274-7457
Mailing Address - Fax:
Practice Address - Street 1:107 W LAKE ST STE 103
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1027
Practice Address - Country:US
Practice Address - Phone:630-351-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor