Provider Demographics
NPI:1790826253
Name:DAVID A. SHIELDS, D.C., P.C.
Entity Type:Organization
Organization Name:DAVID A. SHIELDS, D.C., P.C.
Other - Org Name:DEPOT CHIROPRACTOR DR. SHIELDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT FOR LIFE
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-644-6640
Mailing Address - Street 1:21 PLANK AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1785
Mailing Address - Country:US
Mailing Address - Phone:610-644-6640
Mailing Address - Fax:610-644-6641
Practice Address - Street 1:21 PLANK AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1785
Practice Address - Country:US
Practice Address - Phone:610-644-6640
Practice Address - Fax:610-644-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002446L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0877346000OtherKHPE GROUP NUMBER
PA0877346000OtherBC GROUP NUMBER
PA0877346000OtherKHPE GROUP NUMBER
PASH164898Medicare ID - Type UnspecifiedMEDICARE ID NUMBER