Provider Demographics
NPI:1255474904
Name:SHEPARD, CYNTHIA L (DC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:L
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24875 PANAMA AVE
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:MN
Mailing Address - Zip Code:55020-9485
Mailing Address - Country:US
Mailing Address - Phone:952-461-2975
Mailing Address - Fax:
Practice Address - Street 1:24875 PANAMA AVE
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:MN
Practice Address - Zip Code:55020-9485
Practice Address - Country:US
Practice Address - Phone:952-461-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV06165Medicare UPIN