Healthcare Provider Details

I. General information

NPI: 1184665028
Provider Name (Legal Business Name): TATIYANA M URBIN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9631 GROSS POINT RD SUITE 107
SKOKIE IL
60076-1264
US

IV. Provider business mailing address

9801 GROSS POINT RD SUITE 203
SKOKIE IL
60076-1173
US

V. Phone/Fax

Practice location:
  • Phone: 847-677-4717
  • Fax: 847-677-4717
Mailing address:
  • Phone: 847-677-4717
  • Fax: 847-677-4717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009006
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: