Provider Demographics
NPI:1497307722
Name:DIMOVA, HRISTINA L I (MSOM,LAC)
Entity Type:Individual
Prefix:MISS
First Name:HRISTINA
Middle Name:L
Last Name:DIMOVA
Suffix:I
Gender:F
Credentials:MSOM,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 DEMPSTER ST APT 206
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-5029
Mailing Address - Country:US
Mailing Address - Phone:872-806-7191
Mailing Address - Fax:
Practice Address - Street 1:718 DEMPSTER ST APT 206
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-5029
Practice Address - Country:US
Practice Address - Phone:872-806-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist