Provider Demographics
NPI:1255561858
Name:HARA, ANEIL (DC)
Entity type:Individual
Prefix:
First Name:ANEIL
Middle Name:
Last Name:HARA
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 1:3055 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3862
Mailing Address - Country:US
Mailing Address - Phone:773-376-0665
Mailing Address - Fax:773-767-3944
Practice Address - Street 1:4367 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2826
Practice Address - Country:US
Practice Address - Phone:773-376-0665
Practice Address - Fax:773-767-3944
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038010670OtherLICENSE NUMBER