Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 038012021 | IL |
Y | 111NR0200X | Radiology | 038012021 | IL |
Y | 213ER0200X | Radiology | 038012021 | IL |
NPI | 1184023046 |
---|---|
Provider Name | Yuri Korvatko |
First Address | Lombard, IL 60148-4850 |
Second Address | Lombard, IL 60148-4850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2014 |
Last Update Date | 17/08/2014 |