=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649395518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLA MILIKOVSKY LICAC, DIPLAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3823 N CLARK ST SUITE 1
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60613-2811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-525-4349
-----------------------------------------------------
Fax | 773-572-6073
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3150 N LAKE SHORE DR APT 32B
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-4810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-525-4349
-----------------------------------------------------
Fax | 773-572-6073
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------