Individual
SERGEY VIKTOROVICH DERGACHEV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9933 LAWLER AVE, SUITE 520, SKOKIE, IL 60077-3703
(847) 763-1775
Mailing address
1694 HOPI TRL, WHEELING, IL 60090-5126
(847) 334-9110
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.004427
IL
Other
Enumeration date
10/12/2009
Last updated
10/12/2009
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