Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | IL |
NPI | 1003823287 |
---|---|
Provider Name | Dr. Igor Lukashevsky |
First Address | Buffalo Grove, IL 60089-3704 |
Second Address | Buffalo Grove, IL 60089-3704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U78560 | (02) | IL |