Provider Demographics
NPI:1093792434
Name:SHIELDS, DAVID PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:SHIELDS
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:PO BOX 205
Mailing Address - Street 2:SHIELDS CHIROPRACTIC CLINIC
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-0205
Mailing Address - Country:US
Mailing Address - Phone:724-834-7882
Mailing Address - Fax:724-834-7886
Practice Address - Street 1:RR 3 BOX 299P
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-9754
Practice Address - Country:US
Practice Address - Phone:724-834-7882
Practice Address - Fax:724-834-7886
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003499L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010959110003Medicaid
PA0010959110003Medicaid
U19793Medicare UPIN