Provider Demographics
NPI:1467543959
Name:STODDARD, SHAWN PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:PAUL
Last Name:STODDARD
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 1:7366 BROADWAY
Mailing Address - Street 2:SUITE C & D
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1538
Mailing Address - Country:US
Mailing Address - Phone:619-466-0806
Mailing Address - Fax:619-466-5012
Practice Address - Street 1:7366 BROADWAY
Practice Address - Street 2:SUITE C & D
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1538
Practice Address - Country:US
Practice Address - Phone:619-466-0806
Practice Address - Fax:619-466-5012
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 17832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor