Provider Demographics
NPI:1649239252
Name:IAQUINTA, AMY ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELIZABETH
Last Name:IAQUINTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:SHARIATZADEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1920 SUNSET RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:847-729-1288
Mailing Address - Fax:847-729-0882
Practice Address - Street 1:2700 PATRIOT BLVD STE 250
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8021
Practice Address - Country:US
Practice Address - Phone:847-729-1288
Practice Address - Fax:847-729-0882
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2115111NS0005X
IL038008090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2215Medicaid
SCCH2215Medicaid
SCU668320281Medicare ID - Type Unspecified