Provider Demographics
NPI:1144590076
Name:VIRDI-HULSEBUS, SURACHNA (DC)
Entity Type:Individual
Prefix:DR
First Name:SURACHNA
Middle Name:
Last Name:VIRDI-HULSEBUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SURACHNA
Other - Middle Name:
Other - Last Name:VIRDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1010 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-2518
Mailing Address - Country:US
Mailing Address - Phone:815-654-1044
Mailing Address - Fax:
Practice Address - Street 1:1010 HARLEM RD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-2518
Practice Address - Country:US
Practice Address - Phone:815-654-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor