Individual provider Active NPI

Valerian Kravtsov, D.C.

  • Internist Chiropractor
  • Des Plaines, IL
National Provider Identifier
1629113709
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internist ChiropractorTaxonomy code 111NI0900X
Practice address
1645 S Des Plaines River Rd
Suite 14
Des Plaines, IL 60018
Phone
(847) 361-4971
Fax
(847) 296-2922
NPI assigned
Feb 20, 2007
Last updated
Oct 11, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internist Chiropractor 111NI0900X IL Primary

Addresses

Primary practice location

1645 S Des Plaines River Rd
Suite 14
Des Plaines, IL 60018

Mailing address

1800 Ridge Ave
#203
Evanston, IL 60201-3696
Phone (847) 361-4971

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

LicenseStateTypeSpecialty
0-38008582ILMDInternist Chiropractor

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192060800000",
    "number": "1629113709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 RIDGE AVE",
            "address_2": "#203",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013696",
            "telephone_number": "847-361-4971",
            "fax_number": "847-296-2922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 S DES PLAINES RIVER RD",
            "address_2": "SUITE 14",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "60018",
            "telephone_number": "847-361-4971",
            "fax_number": "847-296-2922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAVTSOV",
        "first_name": "VALERIAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NI0900X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Internist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Plaines, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.