Provider Demographics
NPI:1538376900
Name:SHAPONA, DAVID G (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:SHAPONA
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 1:1301 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1336
Mailing Address - Country:US
Mailing Address - Phone:650-583-5375
Mailing Address - Fax:650-583-5140
Practice Address - Street 1:1301 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1336
Practice Address - Country:US
Practice Address - Phone:650-583-5375
Practice Address - Fax:650-583-5140
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0235880Medicare ID - Type Unspecified