Provider Demographics
NPI:1346339793
Name:SHIMOHARA, RONALD S (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:S
Last Name:SHIMOHARA
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 1:16700 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3243
Mailing Address - Country:US
Mailing Address - Phone:310-371-0905
Mailing Address - Fax:
Practice Address - Street 1:16700 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3243
Practice Address - Country:US
Practice Address - Phone:310-371-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00DC15671Medicaid
CADC0156710OtherBLUE SHIELD
CADC15671OtherBLUE CROSS
CADC15671OtherBLUE CROSS
CADC0156710OtherBLUE SHIELD