Provider Demographics
NPI:1609032168
Name:SHEPHERD, HARRY JACOB IV (DC)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:JACOB
Last Name:SHEPHERD
Suffix:IV
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 1:18 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-1060
Mailing Address - Country:US
Mailing Address - Phone:215-862-9656
Mailing Address - Fax:215-862-9956
Practice Address - Street 1:18 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938-1060
Practice Address - Country:US
Practice Address - Phone:215-862-9656
Practice Address - Fax:215-862-9956
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor