Healthcare Provider Details

I. General information

NPI: 1942429436
Provider Name (Legal Business Name): GUDAVALLI CHIROPRACTIC, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 S WASHINGTON ST SUITE 140
NAPERVILLE IL
60565-6370
US

IV. Provider business mailing address

2603 S. WASHINGTON ST SUITE 140
NAPERVILLE IL
60565
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-1303
  • Fax:
Mailing address:
  • Phone: 630-355-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. SHARINA GUDAVALLI
Title or Position: PRESIDENT
Credential:
Phone: 630-355-1303