Healthcare Provider Details

I. General information

NPI: 1326597626
Provider Name (Legal Business Name): ACUCHIRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2996 E MEADOWVIEW DR
GILBERT AZ
85298-5724
US

IV. Provider business mailing address

2996 E MEADOWVIEW DR
GILBERT AZ
85298-5724
US

V. Phone/Fax

Practice location:
  • Phone: 330-501-5136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number8429
License Number StateAZ

VIII. Authorized Official

Name: DR. SITHARI EDIRISOORIYA
Title or Position: C.E.O.
Credential: D.C.
Phone: 330-501-5136