Healthcare Provider Details

I. General information

NPI: 1790929594
Provider Name (Legal Business Name): D. ANAYA PALAY L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 PLAINFIELD RD SUITE E
WILLOWBROOK IL
60527-7600
US

IV. Provider business mailing address

4112 N FRANCISCO AVE
CHICAGO IL
60618-2604
US

V. Phone/Fax

Practice location:
  • Phone: 630-321-2296
  • Fax:
Mailing address:
  • Phone: 773-505-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.000763
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: