Provider Demographics
NPI:1508079765
Name:WALDMAN, SHAUN (DC)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:WALDMAN
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 1:10624 S EASTERN AVE STE Q
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2975
Mailing Address - Country:US
Mailing Address - Phone:702-617-8676
Mailing Address - Fax:702-617-8678
Practice Address - Street 1:10624 S EASTERN AVE STE Q
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2975
Practice Address - Country:US
Practice Address - Phone:702-617-8676
Practice Address - Fax:702-617-8678
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor