1790826253 NPI number — DAVID A. SHIELDS, D.C., P.C.

Table of content: (NPI 1790826253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790826253 NPI number — DAVID A. SHIELDS, D.C., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID A. SHIELDS, D.C., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DEPOT CHIROPRACTOR DR. SHIELDS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790826253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 PLANK AVE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
PAOLI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19301-1785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-644-6640
Provider Business Mailing Address Fax Number:
610-644-6641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 PLANK AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19301-1785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-644-6640
Provider Business Practice Location Address Fax Number:
610-644-6641
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHIELDS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT FOR LIFE
Authorized Official Telephone Number:
610-644-6640

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC002446L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0877346000 . This is a "KHPE GROUP NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0877346000 . This is a "BC GROUP NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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