Provider Demographics
NPI:1972613701
Name:ADVANCED REHABILITATION CENTER,P.C.
Entity type:Organization
Organization Name:ADVANCED REHABILITATION CENTER,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:NARODITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-293-5690
Mailing Address - Street 1:12829 W SANCTUARY LN
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1167
Mailing Address - Country:US
Mailing Address - Phone:847-293-5690
Mailing Address - Fax:847-541-7933
Practice Address - Street 1:1020 MILWAUKEE AVE STE 242
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3562
Practice Address - Country:US
Practice Address - Phone:847-293-5690
Practice Address - Fax:847-541-7933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-008205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009089Medicaid
209555Medicare ID - Type Unspecified