Provider Demographics
NPI:1336259282
Name:NARODITSKY, ALEKSANDR B (DC)
Entity Type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:B
Last Name:NARODITSKY
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 1:12829 W SANCTUARY LN
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1167
Mailing Address - Country:US
Mailing Address - Phone:847-293-5690
Mailing Address - Fax:847-541-7933
Practice Address - Street 1:1020 MILWAUKEE AVE
Practice Address - Street 2:STE 242
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3562
Practice Address - Country:US
Practice Address - Phone:847-293-5690
Practice Address - Fax:847-541-7933
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001627416OtherBCBS
IL0001627416OtherBCBS
ILU84213Medicare UPIN