Healthcare Provider Details

I. General information

NPI: 1013535764
Provider Name (Legal Business Name): MY ABSOLUTE BODY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 N ARLINGTON HEIGHTS RD STE 101W
ARLINGTON HEIGHTS IL
60004-3976
US

IV. Provider business mailing address

PO BOX 4901
BUFFALO GROVE IL
60089-4901
US

V. Phone/Fax

Practice location:
  • Phone: 847-870-8955
  • Fax: 847-770-4458
Mailing address:
  • Phone: 847-870-8955
  • Fax: 847-770-4458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DIMITRY LIKTEREV
Title or Position: PRES
Credential: DC
Phone: 847-414-3517