Provider Demographics
NPI:1346221314
Name:POTEKHIN, YELENA Y (DC)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:Y
Last Name:POTEKHIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16532 OAK PARK AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1918
Mailing Address - Country:US
Mailing Address - Phone:708-532-0000
Mailing Address - Fax:708-532-0030
Practice Address - Street 1:16532 OAK PARK AVE
Practice Address - Street 2:STE 100
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1918
Practice Address - Country:US
Practice Address - Phone:708-532-0000
Practice Address - Fax:708-532-0030
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL573020Medicare ID - Type Unspecified