Provider Demographics
NPI:1144461294
Name:DECLOEDT, SHAWN STUART (DC)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:STUART
Last Name:DECLOEDT
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:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93062-1209
Mailing Address - Country:US
Mailing Address - Phone:805-581-2310
Mailing Address - Fax:805-582-0003
Practice Address - Street 1:3655 ALAMO ST STE 201
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2187
Practice Address - Country:US
Practice Address - Phone:805-581-2310
Practice Address - Fax:805-335-2439
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11161111N00000X
CADC-31311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor