Provider Demographics
NPI:1861452856
Name:GORDIN, VLADIMIR (DC)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:GORDIN
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 1:688 GREENWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:847-243-2110
Mailing Address - Fax:847-243-2118
Practice Address - Street 1:350 EAST DUNDEE ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090
Practice Address - Country:US
Practice Address - Phone:847-243-2110
Practice Address - Fax:847-243-2118
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009488111N00000X
IL038-009488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1861452856Medicaid
IL038009488Medicaid
ILK20178Medicare ID - Type Unspecified
ILK20178Medicare PIN
ILU87902Medicare UPIN