Provider Demographics
NPI:1598765620
Name:SILVA, SHAWN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:PATRICK
Last Name:SILVA
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 1:12240 CORTE SABIO
Mailing Address - Street 2:#1209
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4500
Mailing Address - Country:US
Mailing Address - Phone:858-385-0409
Mailing Address - Fax:619-224-5489
Practice Address - Street 1:3405 KENYON ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5003
Practice Address - Country:US
Practice Address - Phone:619-224-5371
Practice Address - Fax:619-224-5489
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU75972Medicare UPIN
CADC25804Medicare ID - Type Unspecified