Provider Demographics
NPI:1063633501
Name:SHEPHERD, MATTHEW HUGH (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HUGH
Last Name:SHEPHERD
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 1:279 PLACERVILLE DR
Mailing Address - Street 2:SUITE K
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3931
Mailing Address - Country:US
Mailing Address - Phone:530-621-4090
Mailing Address - Fax:
Practice Address - Street 1:279 PLACERVILLE DR
Practice Address - Street 2:SUITE K
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3931
Practice Address - Country:US
Practice Address - Phone:530-621-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0282870Medicare PIN