Provider Demographics
NPI:1013535764
Name:MY ABSOLUTE BODY INC
Entity Type:Organization
Organization Name:MY ABSOLUTE BODY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:DR. DIMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIKTEREV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-414-3517
Mailing Address - Street 1:PO BOX 4901
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4901
Mailing Address - Country:US
Mailing Address - Phone:847-870-8955
Mailing Address - Fax:847-770-4458
Practice Address - Street 1:1655 N ARLINGTON HEIGHTS RD STE 101W
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3976
Practice Address - Country:US
Practice Address - Phone:847-870-8955
Practice Address - Fax:847-770-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty