Provider Demographics
NPI:1447665849
Name:DSPDC, LLC
Entity type:Organization
Organization Name:DSPDC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIPALI
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-203-3132
Mailing Address - Street 1:PO BOX 5799
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-5799
Mailing Address - Country:US
Mailing Address - Phone:352-515-1630
Mailing Address - Fax:
Practice Address - Street 1:1614 W CENTRAL RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2490
Practice Address - Country:US
Practice Address - Phone:847-259-8777
Practice Address - Fax:847-259-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDS344ZMedicare UPIN