Provider Demographics
NPI:1164690962
Name:MAYEDA, DOLAN SHIG (DC)
Entity Type:Individual
Prefix:
First Name:DOLAN
Middle Name:SHIG
Last Name:MAYEDA
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 1:4025 CAMINO DEL RIO S
Mailing Address - Street 2:STE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-542-7744
Mailing Address - Fax:619-542-7745
Practice Address - Street 1:4025 CAMINO DEL RIO S
Practice Address - Street 2:STE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-542-7744
Practice Address - Fax:619-542-7745
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor