Provider Demographics
NPI:1417158718
Name:SHAFFER, STEVEN ERIC (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ERIC
Last Name:SHAFFER
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 1:3188 AIRWAY AVE
Mailing Address - Street 2:BLDG E
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4652
Mailing Address - Country:US
Mailing Address - Phone:714-540-0555
Mailing Address - Fax:714-540-0585
Practice Address - Street 1:3188 AIRWAY AVE
Practice Address - Street 2:BLDG E
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:714-540-0555
Practice Address - Fax:714-540-0585
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA24056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor