Provider Demographics
NPI:1275718728
Name:SHAWN D DOERRFELD DC PL
Entity Type:Organization
Organization Name:SHAWN D DOERRFELD DC PL
Other - Org Name:DOERRFELD CHIROPRACTIC INJURY & WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DOERRFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-986-1966
Mailing Address - Street 1:50 LEANNI WAY UNIT D1
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4756
Mailing Address - Country:US
Mailing Address - Phone:386-986-1966
Mailing Address - Fax:
Practice Address - Street 1:50 LEANNI WAY UNIT D1
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4756
Practice Address - Country:US
Practice Address - Phone:386-986-1966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty