Provider Demographics
NPI:1942429436
Name:GUDAVALLI CHIROPRACTIC, LTD
Entity Type:Organization
Organization Name:GUDAVALLI CHIROPRACTIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUDAVALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-355-1303
Mailing Address - Street 1:2603 S. WASHINGTON ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565
Mailing Address - Country:US
Mailing Address - Phone:630-355-1303
Mailing Address - Fax:
Practice Address - Street 1:2603 S WASHINGTON ST
Practice Address - Street 2:SUITE 140
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-6370
Practice Address - Country:US
Practice Address - Phone:630-355-1303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty