Provider Demographics
NPI:1568114940
Name:SHARASHIDZE, MAIA (DC)
Entity Type:Individual
Prefix:
First Name:MAIA
Middle Name:
Last Name:SHARASHIDZE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 N ARLINGTON HEIGHTS RD STE 101W
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3976
Mailing Address - Country:US
Mailing Address - Phone:847-870-8955
Mailing Address - Fax:
Practice Address - Street 1:1655 N ARLINGTON HEIGHTS RD STE 101W
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3976
Practice Address - Country:US
Practice Address - Phone:847-870-8955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor