Healthcare Provider Details

I. General information

NPI: 1992828339
Provider Name (Legal Business Name): MEHRAN R. SOROURI D.C., DACO, CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 W BELMONT AVE
CHICAGO IL
60618-6467
US

IV. Provider business mailing address

2051 W BELMONT AVE
CHICAGO IL
60618-6467
US

V. Phone/Fax

Practice location:
  • Phone: 773-525-8100
  • Fax: 773-525-8130
Mailing address:
  • Phone: 773-525-8100
  • Fax: 773-525-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-009498
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: