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General NPI Number Information
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NPI Number | 1972613701
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Entity Type | Organization
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Legal Business Name | ADVANCED REHABILITATION CENTER,P.C.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 1020 MILWAUKEE AVE STE 242
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City | DEERFIELD
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State | IL
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Zip | 60015-3562
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Country | US
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Telephone | 847-293-5690
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Fax | 847-541-7933
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Provider Business Mailing Address
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Address Line | 12829 W SANCTUARY LN
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1167
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Country | US
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Telephone | 847-293-5690
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Fax | 847-541-7933
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEKSANDR NARODITSKY
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Credential | D.C.
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Telephone | 847-293-5690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 060-008205
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License Number State | IL
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