Provider Demographics
NPI:1013023712
Name:SHAEVITZ, KEVIN LAWRENCE (CHIROPRACTOR DC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LAWRENCE
Last Name:SHAEVITZ
Suffix:
Gender:M
Credentials:CHIROPRACTOR DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22222 LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887
Mailing Address - Country:US
Mailing Address - Phone:714-692-7138
Mailing Address - Fax:714-692-7141
Practice Address - Street 1:22222 LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887
Practice Address - Country:US
Practice Address - Phone:714-692-7138
Practice Address - Fax:714-692-7141
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC23109Medicare UPIN
CADC23109Medicare ID - Type Unspecified