Individual provider Active NPI

Aleksandr B Naroditsky, D.C.

  • Chiropractor
  • Deerfield, IL
National Provider Identifier
1336259282
Registry record updated Nov 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-009089 Issued in IL
Practice address
1020 Milwaukee Ave
Ste 242
Deerfield, IL 60015-3562
Phone
(847) 293-5690
Fax
(847) 541-7933
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038-009089 IL Primary

Addresses

Primary practice location

1020 Milwaukee Ave
Ste 242
Deerfield, IL 60015-3562

Mailing address

12829 W Sanctuary LN
Lake Bluff, IL 60044-1167
Phone (847) 293-5690

Other identifiers 1

IdentifierTypeStateIssuer
0001627416OtherILBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040823000129 IL Practitioner - Chiropractic 2668364399 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12829 W Sanctuary LN
Lake Bluff, IL 60044-1167
Phone (847) 293-5690

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-009089ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Rehabilitation Center,P.C. Chiropractor CurrentSince Jun 9, 2004 Accepting new patients
Aleksandr Naroditsky, D.C. Past Accepting new patients

Locations

2549 Waukegan Rd
Bannockburn, IL 60015
Phone (833) 831-8163

1020 Milwaukee Ave
Ste 242
Deerfield, IL 60015
Phone (224) 475-3990

301 S County Farm Rd
Wheaton, IL 60187
Phone (630) 588-0055

401 S Milwaukee Ave
Ste 220
Wheeling, IL 60090
Phone (847) 541-7933

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1336259282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12829 W SANCTUARY LN",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "600441167",
            "telephone_number": "847-293-5690",
            "fax_number": "847-541-7933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 MILWAUKEE AVE",
            "address_2": "STE 242",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600153562",
            "telephone_number": "847-293-5690",
            "fax_number": "847-541-7933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NARODITSKY",
        "first_name": "ALEKSANDR",
        "middle_name": "B",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-009089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0001627416",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deerfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.