Provider Demographics
NPI:1275610842
Name:SHAPIRO, MARK B
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:B
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:B
Other - Last Name:SHAPIRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3300 WEBSTER ST STE 408
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3149
Mailing Address - Country:US
Mailing Address - Phone:510-444-2772
Mailing Address - Fax:510-444-2773
Practice Address - Street 1:3300 WEBSTER ST STE 408
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3149
Practice Address - Country:US
Practice Address - Phone:510-444-2772
Practice Address - Fax:510-444-2773
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 19278111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 0192780Medicare ID - Type UnspecifiedMEDICARE