Healthcare Provider Details

I. General information

NPI: 1316097611
Provider Name (Legal Business Name): MIRA DHUTIA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRA KACHRANI D.C

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 MONTGOMERY RD SUITE # 21
AURORA IL
60504-3149
US

IV. Provider business mailing address

3450 MONTGOMERY RD SUITE # 21
AURORA IL
60504-3149
US

V. Phone/Fax

Practice location:
  • Phone: 630-236-8600
  • Fax: 630-236-8612
Mailing address:
  • Phone: 630-236-8600
  • Fax: 630-236-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-009287
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: