Provider Demographics
NPI:1184724874
Name:JSK MEDICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:JSK MEDICAL ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-388-8026
Mailing Address - Street 1:107 W LAKE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1027
Mailing Address - Country:US
Mailing Address - Phone:630-351-0222
Mailing Address - Fax:773-767-3944
Practice Address - Street 1:107 W LAKE ST
Practice Address - Street 2:SUITE 103
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:773-767-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02233015OtherBCBS PROVIDER #
IL214347Medicare PIN