Healthcare Provider Details

I. General information

NPI: 1609900950
Provider Name (Legal Business Name): KIYOSHI GARY MURAKAMI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 129TH INFANTRY DR.
JOLIET IL
60435
US

IV. Provider business mailing address

4248 BELLEAIRE LANE
DOWNERS GROVE IL
60515
US

V. Phone/Fax

Practice location:
  • Phone: 815-355-4450
  • Fax:
Mailing address:
  • Phone: 630-324-4730
  • Fax: 630-324-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: