Provider Demographics
NPI:1821463407
Name:SHISHIDO, DAREN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAREN
Middle Name:
Last Name:SHISHIDO
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 1:14891 N FITZWILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-5081
Mailing Address - Country:US
Mailing Address - Phone:208-830-4481
Mailing Address - Fax:
Practice Address - Street 1:304 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5015
Practice Address - Country:US
Practice Address - Phone:208-830-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor