Healthcare Provider Details

I. General information

NPI: 1649239252
Provider Name (Legal Business Name): AMY ELIZABETH IAQUINTA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY SHARIATZADEH D.C.

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 PATRIOT BLVD STE 250
GLENVIEW IL
60026-8021
US

IV. Provider business mailing address

1920 SUNSET RIDGE RD.
GLENVIEW IL
60025
US

V. Phone/Fax

Practice location:
  • Phone: 847-729-1288
  • Fax: 847-729-0882
Mailing address:
  • Phone: 847-729-1288
  • Fax: 847-729-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2115
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008090
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: