Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | 13385 | TX |
NPI | 1740727114 |
---|---|
Provider Name | Darya Ilushin |
First Address | Flower Mound, TX 75028-1864 |
Second Address | Flower Mound, TX 75028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2017 |
Last Update Date | 23/08/2018 |