Provider Demographics
NPI:1861426702
Name:EMAN, SHAHROUZ (DC)
Entity type:Individual
Prefix:
First Name:SHAHROUZ
Middle Name:
Last Name:EMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8028
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:1057 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2504
Practice Address - Country:US
Practice Address - Phone:805-270-1700
Practice Address - Fax:805-481-7097
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447277488OtherCOASTAL MEDICAL CENTER NPI
CAFHC70737FOtherMEDICAID-LOS ROBLES MEDICAL CENTER
CA1124045042OtherLOS ROBLES MEDICAL CENTER NPI
CA551905OtherLOS ROBLES MED CENTER MEDICARE GROUP
CA551903OtherMEDICARE UGS COASTAL MEDICAL CENTER
CAW1508OtherMEDICARE GROUP ID LOS ROBLES MEDICAL CENTER
CAW1508OtherCOASTAL MEDICAL CENTER MEDICARE GROUP
CAFHC70593FMedicaid
CAW1508OtherMEDICARE GROUP ID LOS ROBLES MEDICAL CENTER
CAWDC27053AMedicare Oscar/Certification