Provider Demographics
NPI:1063587475
Name:NEXPERT INC
Entity type:Organization
Organization Name:NEXPERT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:PISAREV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-769-6420
Mailing Address - Street 1:1336 NEWPORT ST
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-4624
Mailing Address - Country:US
Mailing Address - Phone:847-679-6480
Mailing Address - Fax:
Practice Address - Street 1:4853 OAKTON ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2955
Practice Address - Country:US
Practice Address - Phone:847-679-6480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212061Medicare ID - Type UnspecifiedMEDICARE GROUP#
ILU85131Medicare UPIN