Provider Demographics
NPI:1821152372
Name:DACHEPALLI, CHANDRA SRINIVAS (AUD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:SRINIVAS
Last Name:DACHEPALLI
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 PROVIDENCE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-3124
Mailing Address - Country:US
Mailing Address - Phone:630-267-1869
Mailing Address - Fax:630-225-5103
Practice Address - Street 1:7530 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3100
Practice Address - Country:US
Practice Address - Phone:630-985-4884
Practice Address - Fax:630-225-5103
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist