Provider Demographics
NPI:1265637144
Name:SHAKIB, MAMAK (DC)
Entity Type:Individual
Prefix:DR
First Name:MAMAK
Middle Name:
Last Name:SHAKIB
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MAMAK
Other - Middle Name:
Other - Last Name:SHAKIB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15785 LAGUNA CANYON RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3165
Mailing Address - Country:US
Mailing Address - Phone:949-552-5535
Mailing Address - Fax:949-552-3022
Practice Address - Street 1:15785 LAGUNA CANYON RD
Practice Address - Street 2:SUITE 110
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3165
Practice Address - Country:US
Practice Address - Phone:949-552-5535
Practice Address - Fax:949-552-3022
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor