Provider Demographics
NPI:1528394137
Name:LOVDAHL, SHAWN DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:DOUGLAS
Last Name:LOVDAHL
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 1:13951 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-3678
Mailing Address - Country:US
Mailing Address - Phone:320-761-4217
Mailing Address - Fax:
Practice Address - Street 1:6831 JEWEL LAKE RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-2823
Practice Address - Country:US
Practice Address - Phone:907-245-0807
Practice Address - Fax:907-245-0809
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor