Provider Demographics
NPI:1134898083
Name:NAJIMI, ILIASS (DC)
Entity type:Individual
Prefix:
First Name:ILIASS
Middle Name:
Last Name:NAJIMI
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 1:665 W DIVERSEY AVE APT 2W
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3242
Mailing Address - Country:US
Mailing Address - Phone:312-532-6902
Mailing Address - Fax:
Practice Address - Street 1:665 W DIVERSEY AVE APT 2W
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3242
Practice Address - Country:US
Practice Address - Phone:312-532-6902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor