Provider Demographics
NPI:1063830537
Name:DR. KEVIN SHAEVITZ CHIROPRACTIC INC
Entity Type:Organization
Organization Name:DR. KEVIN SHAEVITZ CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAEVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-692-7139
Mailing Address - Street 1:22222 LA PALMA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887
Mailing Address - Country:US
Mailing Address - Phone:714-692-7139
Mailing Address - Fax:
Practice Address - Street 1:22222 LA PALMA AVE
Practice Address - Street 2:STE A
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-3813
Practice Address - Country:US
Practice Address - Phone:714-692-7139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 23109111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty