Healthcare Provider Details

I. General information

NPI: 1184805947
Provider Name (Legal Business Name): SOHEILA VAHABI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOHEILA VAHABI DC

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 N LINCOLN AVE
CHICAGO IL
60625-2009
US

IV. Provider business mailing address

1603 ORRINGTON AVE STE 600
EVANSTON IL
60201-3860
US

V. Phone/Fax

Practice location:
  • Phone: 312-774-0010
  • Fax:
Mailing address:
  • Phone: 312-774-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number38008001
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: