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General NPI Number Information
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NPI Number | 1730350877
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Entity Type | Individual
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Provider Name | IVAN NARKEVITCH L.AC.
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Gender | Male
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 985 S BUFFALO GROVE RD
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-3702
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Country | US
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Telephone | 847-681-1161
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Fax | 847-681-1161
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Provider Business Mailing Address
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Address Line | 4711 GOLF RD SUITE # 525
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City | SKOKIE
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State | IL
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Zip | 60076-1224
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Country | US
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Telephone | 847-525-0048
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Fax | 847-675-2006
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198000632
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227014581
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License Number State | IL
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