Provider Demographics
NPI:1942432000
Name:GUREVICH, EDWARD SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SAMUEL
Last Name:GUREVICH
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 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:STE 301N
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:630-320-6400
Mailing Address - Fax:630-701-1007
Practice Address - Street 1:175 W JACKSON BLVD STE 2150
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-2613
Practice Address - Country:US
Practice Address - Phone:312-262-6224
Practice Address - Fax:312-262-6227
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011305111N00000X
MN5171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor