Provider Demographics
NPI:1447282678
Name:VYAS, PRANAV P (DC, FIAMA)
Entity type:Individual
Prefix:DR
First Name:PRANAV
Middle Name:P
Last Name:VYAS
Suffix:
Gender:M
Credentials:DC, FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 ELA RD
Mailing Address - Street 2:STE B
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2412
Mailing Address - Country:US
Mailing Address - Phone:847-550-6500
Mailing Address - Fax:847-550-6595
Practice Address - Street 1:755 ELA RD STE B
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2412
Practice Address - Country:US
Practice Address - Phone:847-550-6500
Practice Address - Fax:847-550-6595
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009916111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist