Provider Demographics
NPI:1538595855
Name:GHORESHI, YASHAR (DC)
Entity type:Individual
Prefix:
First Name:YASHAR
Middle Name:
Last Name:GHORESHI
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 1:2016 W CHICAGO AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5548
Mailing Address - Country:US
Mailing Address - Phone:312-931-0389
Mailing Address - Fax:312-668-8603
Practice Address - Street 1:2016 W CHICAGO AVE # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5548
Practice Address - Country:US
Practice Address - Phone:312-788-8070
Practice Address - Fax:312-668-8603
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012335111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038012335OtherILLINOIS STATE LICENSE