Provider Demographics
NPI:1871882464
Name:SHEPHERD CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SHEPHERD CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVIA
Authorized Official - Middle Name:HYACINTH
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-695-1489
Mailing Address - Street 1:21 UPSON PL
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1116
Mailing Address - Country:US
Mailing Address - Phone:203-695-1489
Mailing Address - Fax:
Practice Address - Street 1:665 TERRYVILLE AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4078
Practice Address - Country:US
Practice Address - Phone:860-589-1491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty