Provider Demographics
NPI:1164792446
Name:SLAVKOV, EMIL KIRILOV (LMT, LAC)
Entity Type:Individual
Prefix:MR
First Name:EMIL
Middle Name:KIRILOV
Last Name:SLAVKOV
Suffix:
Gender:M
Credentials:LMT, LAC
Other - Prefix:
Other - First Name:EMIL
Other - Middle Name:
Other - Last Name:SLAVKOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 RENAISSANCE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1329
Mailing Address - Country:US
Mailing Address - Phone:847-962-9199
Mailing Address - Fax:
Practice Address - Street 1:1400 RENAISSANCE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1329
Practice Address - Country:US
Practice Address - Phone:847-962-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000932171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist