Provider Demographics
NPI:1316097611
Name:DHUTIA, MIRA (DC)
Entity type:Individual
Prefix:DR
First Name:MIRA
Middle Name:
Last Name:DHUTIA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MIRA
Other - Middle Name:
Other - Last Name:KACHRANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:3450 MONTGOMERY RD
Mailing Address - Street 2:SUITE # 21
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-3149
Mailing Address - Country:US
Mailing Address - Phone:630-236-8600
Mailing Address - Fax:630-236-8612
Practice Address - Street 1:3450 MONTGOMERY RD
Practice Address - Street 2:SUITE # 21
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-3149
Practice Address - Country:US
Practice Address - Phone:630-236-8600
Practice Address - Fax:630-236-8612
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1093891798OtherNPI TYPE 2 FOR SRWC
IL364447019OtherTAX ID #
IL1093891798OtherNPI TYPE 2 FOR SRWC