Provider Demographics
NPI:1184805947
Name:VAHABI, SOHEILA
Entity type:Individual
Prefix:
First Name:SOHEILA
Middle Name:
Last Name:VAHABI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOHEILA
Other - Middle Name:
Other - Last Name:VAHABI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1603 ORRINGTON AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3860
Mailing Address - Country:US
Mailing Address - Phone:312-774-0010
Mailing Address - Fax:
Practice Address - Street 1:4705 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2009
Practice Address - Country:US
Practice Address - Phone:312-774-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38008001111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK47133Medicare PIN