Provider Demographics
NPI:1871899484
Name:KHAN, VIJAI PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:VIJAI
Middle Name:PAUL
Last Name:KHAN
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:PO BOX 2195
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-2195
Mailing Address - Country:US
Mailing Address - Phone:715-358-6650
Mailing Address - Fax:715-358-6381
Practice Address - Street 1:103 ELM ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-9164
Practice Address - Country:US
Practice Address - Phone:715-358-6650
Practice Address - Fax:715-358-6381
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4725-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor