Provider Demographics
NPI:1902029937
Name:SHORT, HOWARD MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MICHAEL
Last Name:SHORT
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 1:9420 MIRA MESA BLVD
Mailing Address - Street 2:STE 4D1
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126
Mailing Address - Country:US
Mailing Address - Phone:858-689-2273
Mailing Address - Fax:858-689-8818
Practice Address - Street 1:9420 MIRA MESA BLVD
Practice Address - Street 2:STE 4D1
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126
Practice Address - Country:US
Practice Address - Phone:858-689-2273
Practice Address - Fax:858-689-8818
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T18425Medicare UPIN
CAW14181Medicare ID - Type Unspecified