Provider Demographics
NPI:1568778827
Name:SHEHAIBER, SAMAR SUHEIL (DC MJ CKTP RRT)
Entity Type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:SUHEIL
Last Name:SHEHAIBER
Suffix:
Gender:F
Credentials:DC MJ CKTP RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2503
Mailing Address - Country:US
Mailing Address - Phone:224-723-9038
Mailing Address - Fax:708-598-2002
Practice Address - Street 1:8550 S HARLEM AVE STE B
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1775
Practice Address - Country:US
Practice Address - Phone:708-598-2000
Practice Address - Fax:708-598-2002
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1568778827Medicare UPIN
IL1568778827Medicare NSC
IL1568778827Medicare PIN
IL1568778827Medicare Oscar/Certification