Healthcare Provider Details

I. General information

NPI: 1902926132
Provider Name (Legal Business Name): MIDWEST EXAMINATION SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 SHERIDAN RD
ZION IL
60099-2615
US

IV. Provider business mailing address

PO BOX 6102
BUFFALO GROVE IL
60089-6102
US

V. Phone/Fax

Practice location:
  • Phone: 847-731-6727
  • Fax:
Mailing address:
  • Phone: 847-414-3517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 5
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