Provider Demographics
NPI:1376921437
Name:AMERICAN STYLE LLC
Entity Type:Organization
Organization Name:AMERICAN STYLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUCHTCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-357-1090
Mailing Address - Street 1:1663 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2044
Mailing Address - Country:US
Mailing Address - Phone:262-357-1090
Mailing Address - Fax:
Practice Address - Street 1:333 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3545
Practice Address - Country:US
Practice Address - Phone:847-708-1315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-09
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227011643225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty