Active NPI
Tetyana Kostiv
- Occupational Health Chiropractor
- Mundelein, IL
National Provider Identifier
1376943639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Health Chiropractor
- License
- 227.001585
- Practice address
- 300 Anthony Ave Unit 202
Mundelein, IL 60060-2451 - Phone
- (224) 628-0189
- NPI assigned
- Aug 23, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Health Chiropractor | 111NX0100X | 227.001585 | IL | Primary |
Addresses
Primary practice location
300 Anthony Ave Unit 202
Mundelein, IL 60060-2451
Mailing address
300 Anthony Ave Unit 202
Mundelein, IL 60060-2451
Phone (224) 628-0189
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 227.001585 | Other | IL | LICENSED MASSAGE THERAPIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 227.001585 | IL | MD | Occupational Health Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408752000000",
"number": "1376943639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 ANTHONY AVE UNIT 202",
"city": "MUNDELEIN",
"state": "IL",
"postal_code": "600602451",
"telephone_number": "224-628-0189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 ANTHONY AVE UNIT 202",
"city": "MUNDELEIN",
"state": "IL",
"postal_code": "600602451",
"telephone_number": "224-628-0189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSTIV",
"first_name": "TETYANA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-23",
"last_updated": "2014-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "111NX0100X",
"taxonomy_group": "",
"desc": "Chiropractor, Occupational Health",
"state": "IL",
"license": "227.001585",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED MASSAGE THERAPIST",
"identifier": "227.001585",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mundelein, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.