Provider Demographics
NPI:1780781856
Name:BEN-SHAH, DEBORAH (DC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BEN-SHAH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23317 MULHOLLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-591-8847
Mailing Address - Fax:818-591-0549
Practice Address - Street 1:23317 MULHOLLAND DRIVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-591-8847
Practice Address - Fax:818-591-0549
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V06024Medicare UPIN
CADC0287700Medicare ID - Type UnspecifiedBLUE SHIELD