Provider Demographics
NPI:1417132713
Name:HAJARIWALA, SAMIR KISHOR (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:KISHOR
Last Name:HAJARIWALA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 HICKORY WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2995
Mailing Address - Country:US
Mailing Address - Phone:585-410-0643
Mailing Address - Fax:
Practice Address - Street 1:3339 HIGHWAY 34 E STE C
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-3565
Practice Address - Country:US
Practice Address - Phone:770-252-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011599111N00000X
NY011521111N00000X
GA009981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011521OtherNY STATE LISCENCE NUMBER
NYC11521-4BOtherWORKER'S COMPENSATION
IL038.011599OtherIL CHIROPRACTIC PHYSICIAN LICENSE