Provider Demographics
NPI:1033113410
Name:SHAPIRO, ROBERT JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:SHAPIRO
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 1:2087 GRAND CANAL BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6651
Mailing Address - Country:US
Mailing Address - Phone:209-888-8602
Mailing Address - Fax:209-888-8603
Practice Address - Street 1:2087 GRAND CANAL BLVD STE 12
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6651
Practice Address - Country:US
Practice Address - Phone:209-888-8602
Practice Address - Fax:209-888-8603
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0272940Medicare ID - Type Unspecified
CA1033113410Medicare NSC
CA6398460001Medicare NSC
CAV00330Medicare UPIN
CA1669635744Medicare NSC