Provider Demographics
NPI:1780780395
Name:JOSHI, TAPAN (DC)
Entity type:Individual
Prefix:
First Name:TAPAN
Middle Name:
Last Name:JOSHI
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 1:107 W LAKE ST
Mailing Address - Street 2:STE NO103
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 1:117 W LAKE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1006
Practice Address - Country:US
Practice Address - Phone:630-351-0222
Practice Address - Fax:773-767-3944
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205343603OtherTAX ID PRACTICE UNDER
IL02233015OtherBCBS PROVIDER #
IL038009838OtherLICENSE NUMBER
ILK32628Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE