Provider Demographics
NPI:1972666238
Name:BANERJEE, CHANDRACHUR (DC)
Entity Type:Individual
Prefix:
First Name:CHANDRACHUR
Middle Name:
Last Name:BANERJEE
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:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-0946
Mailing Address - Country:US
Mailing Address - Phone:618-692-9802
Mailing Address - Fax:618-692-6711
Practice Address - Street 1:435-B S. BUCHANAN ST.
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-0997
Practice Address - Country:US
Practice Address - Phone:618-692-9802
Practice Address - Fax:618-692-6711
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor