Provider Demographics
NPI:1629087226
Name:KHANNA, RUBY (DC)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:RUBY
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2430 ESPLANADE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5500
Mailing Address - Country:US
Mailing Address - Phone:224-333-3424
Mailing Address - Fax:
Practice Address - Street 1:2430 ESPLANADE DR
Practice Address - Street 2:SUITE B
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5500
Practice Address - Country:US
Practice Address - Phone:224-333-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038-010369OtherLICENSE