Provider Demographics
NPI:1477836450
Name:DOROUGH, MIRAVONE (DC, ND)
Entity Type:Individual
Prefix:DR
First Name:MIRAVONE
Middle Name:
Last Name:DOROUGH
Suffix:
Gender:F
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24W788 75TH ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1684
Mailing Address - Country:US
Mailing Address - Phone:331-442-9912
Mailing Address - Fax:331-333-1802
Practice Address - Street 1:24W788 75TH ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1684
Practice Address - Country:US
Practice Address - Phone:331-442-9912
Practice Address - Fax:331-333-1802
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty