Individual
TETYANA KOSTIV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 ANTHONY AVE UNIT 202, MUNDELEIN, IL 60060-2451
(224) 628-0189
Mailing address
300 ANTHONY AVE UNIT 202, MUNDELEIN, IL 60060-2451
(224) 628-0189
Taxonomy
Speciality
Code
Description
License number
State
111NX0100X
Occupational Health Chiropractor
Primary
227.001585
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
227.001585
LICENSED MASSAGE THERAPIST
IL
Enumeration date
08/23/2014
Last updated
08/23/2014
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