Provider Demographics
NPI:1962601609
Name:KANTHETI, SRAVANTI K (DC)
Entity type:Individual
Prefix:DR
First Name:SRAVANTI
Middle Name:K
Last Name:KANTHETI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SRAVANTI
Other - Middle Name:K
Other - Last Name:CHITTIPROLU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7514 KILBRITTAIN LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-9787
Mailing Address - Country:US
Mailing Address - Phone:614-495-2122
Mailing Address - Fax:
Practice Address - Street 1:99 N BRICE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6510
Practice Address - Country:US
Practice Address - Phone:614-495-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3727111N00000X
GACHIR007874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor