Provider Demographics
NPI:1114376712
Name:HARADA, SHANE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:
Last Name:HARADA
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 1061
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1061
Mailing Address - Country:US
Mailing Address - Phone:801-756-5299
Mailing Address - Fax:801-756-5415
Practice Address - Street 1:872 N 2000 W
Practice Address - Street 2:SUITE A
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-4047
Practice Address - Country:US
Practice Address - Phone:801-756-5299
Practice Address - Fax:801-756-5415
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5366805-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor