Provider Demographics
NPI:1497962104
Name:SHENANDOAH CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:SHENANDOAH CHIROPRACTIC, P.A.
Other - Org Name:SHENANDOAH CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:LESHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-915-9944
Mailing Address - Street 1:13664 W STATE ROAD 84
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-5302
Mailing Address - Country:US
Mailing Address - Phone:954-915-9944
Mailing Address - Fax:954-915-9972
Practice Address - Street 1:13664 W STATE ROAD 84
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-5302
Practice Address - Country:US
Practice Address - Phone:954-915-9944
Practice Address - Fax:954-915-9972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-7465111N00000X
111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55654ZMedicare ID - Type Unspecified
FLU70584Medicare UPIN