Provider Demographics
NPI:1093023640
Name:PORTO, KATERI ASHVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATERI
Middle Name:ASHVIN
Last Name:PORTO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 767
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5302
Mailing Address - Country:US
Mailing Address - Phone:630-306-8177
Mailing Address - Fax:
Practice Address - Street 1:2720 SOUTH HIGHLAND AVE
Practice Address - Street 2:SUITE 767
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4539
Practice Address - Country:US
Practice Address - Phone:630-306-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor