Healthcare Provider Details

I. General information

NPI: 1952614596
Provider Name (Legal Business Name): MILLENIUM WELLNESS CENTER, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 S MICHIGAN AVE SUITE 612
CHICAGO IL
60603-3357
US

IV. Provider business mailing address

8 S MICHIGAN AVE SUITE 612
CHICAGO IL
60603-3357
US

V. Phone/Fax

Practice location:
  • Phone: 847-361-4971
  • Fax:
Mailing address:
  • Phone: 847-361-4971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: VALERIAN KRAVTSOV
Title or Position: PRESIDENT
Credential: D.C.
Phone: 847-361-4971