Provider Demographics
NPI:1184023046
Name:KORVATKO, YURI (DC)
Entity Type:Individual
Prefix:
First Name:YURI
Middle Name:
Last Name:KORVATKO
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 1:2015 S FINLEY RD APT 605
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4850
Mailing Address - Country:US
Mailing Address - Phone:630-396-0262
Mailing Address - Fax:
Practice Address - Street 1:2015 S FINLEY RD APT 605
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4850
Practice Address - Country:US
Practice Address - Phone:630-396-0262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-17
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012021111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
No111N00000XChiropractic ProvidersChiropractor