Provider Demographics
NPI:1467763037
Name:KENDRICK, SHAWN PAUL (DC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:PAUL
Last Name:KENDRICK
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 1:1414W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2648
Mailing Address - Country:US
Mailing Address - Phone:434-392-9807
Mailing Address - Fax:434-392-7081
Practice Address - Street 1:1414W 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2648
Practice Address - Country:US
Practice Address - Phone:434-392-9807
Practice Address - Fax:434-392-7081
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor