Provider Demographics
NPI:1225213101
Name:SHADEMAN, MEHRDAD (DC)
Entity Type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:SHADEMAN
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 1:132 S A ST STE B
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-5690
Mailing Address - Country:US
Mailing Address - Phone:805-487-4043
Mailing Address - Fax:805-487-4003
Practice Address - Street 1:200 N HAYES AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5420
Practice Address - Country:US
Practice Address - Phone:805-486-7300
Practice Address - Fax:805-486-2850
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor