Provider Demographics
NPI:1396964474
Name:ALEKSANDR NARODITSKY, D.C.
Entity type:Organization
Organization Name:ALEKSANDR NARODITSKY, D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:NARODITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-541-7933
Mailing Address - Street 1:2549 WAUKEGAN RD
Mailing Address - Street 2:PMB 187
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1569
Mailing Address - Country:US
Mailing Address - Phone:847-541-7933
Mailing Address - Fax:847-541-7934
Practice Address - Street 1:401 S MILWAUKEE AVE
Practice Address - Street 2:SUTE 220
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5070
Practice Address - Country:US
Practice Address - Phone:847-541-7933
Practice Address - Fax:847-541-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001627416OtherBCBS