Provider Demographics
NPI:1881620102
Name:KHAMPRASEUT, DAN (DC)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:KHAMPRASEUT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:KHAMPRASEUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:530 FULLERTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2970
Mailing Address - Country:US
Mailing Address - Phone:618-233-3324
Mailing Address - Fax:618-233-4758
Practice Address - Street 1:530 FULLERTON RD STE B
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2970
Practice Address - Country:US
Practice Address - Phone:618-233-3324
Practice Address - Fax:618-233-4758
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009696OtherSTATE OF ILLINOIS