Individual
ANATOLY SUBOTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C
Contact information
Practice address
3848 W IRVING PARK RD, CHICAGO, IL 60618-3122
(773) 539-6844
Mailing address
3848 W IRVING PARK RD, CHICAGO, IL 60618-3122
(773) 539-6844
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001682203
BC/BS
IL
Enumeration date
09/29/2006
Last updated
07/08/2007
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