Provider Demographics
NPI:1467453365
Name:SHEYBANI, SHAYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAYAN
Middle Name:
Last Name:SHEYBANI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:SHAYAN
Other - Middle Name:
Other - Last Name:SHEYBANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1000 BRADY ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-5214
Mailing Address - Country:US
Mailing Address - Phone:563-884-5810
Mailing Address - Fax:
Practice Address - Street 1:1000 BRADY ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5214
Practice Address - Country:US
Practice Address - Phone:563-884-5810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42065OtherBLUE CROSS BLUE SHIELD
IA223920016Medicare Oscar/Certification
IAU73624Medicare UPIN