Provider Demographics
NPI:1598760621
Name:SHORE, MICHAEL S (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:SHORE
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 1:29525 CANWOOD ST
Mailing Address - Street 2:STE 204
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4231
Mailing Address - Country:US
Mailing Address - Phone:818-991-3900
Mailing Address - Fax:818-991-4039
Practice Address - Street 1:29525 CANWOOD ST
Practice Address - Street 2:STE 204
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4231
Practice Address - Country:US
Practice Address - Phone:818-991-3900
Practice Address - Fax:818-991-4039
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT95620Medicare UPIN
CADC19987Medicare ID - Type Unspecified