Provider Demographics
NPI:1497951958
Name:SHAKERI, KOROSH (DC)
Entity Type:Individual
Prefix:DR
First Name:KOROSH
Middle Name:
Last Name:SHAKERI
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 1:3280 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2439
Mailing Address - Country:US
Mailing Address - Phone:510-547-1222
Mailing Address - Fax:510-547-8219
Practice Address - Street 1:3280 ADELINE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2439
Practice Address - Country:US
Practice Address - Phone:510-547-1222
Practice Address - Fax:510-547-8219
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor