Provider Demographics
NPI:1649229576
Name:LVOVA, VICTORIA (CH)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:LVOVA
Suffix:
Gender:F
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 N CLARK ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7737
Mailing Address - Country:US
Mailing Address - Phone:773-248-6476
Mailing Address - Fax:773-248-2906
Practice Address - Street 1:2551 N CLARK ST
Practice Address - Street 2:SUITE 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7737
Practice Address - Country:US
Practice Address - Phone:773-248-6476
Practice Address - Fax:773-248-2906
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201649Medicare PIN