Provider Demographics
NPI:1134251234
Name:KOTHARI, RAKESH (DC)
Entity type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:
Last Name:KOTHARI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 N STANTON ST APT 25C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6407
Mailing Address - Country:US
Mailing Address - Phone:832-236-2090
Mailing Address - Fax:
Practice Address - Street 1:2030 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3414
Practice Address - Country:US
Practice Address - Phone:915-351-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor