Provider Demographics
NPI:1972501468
Name:SHIELDS, DAVID ARDIN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ARDIN
Last Name:SHIELDS
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 1:21 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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-09
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
PADC002446L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP1855983OtherOXFORD HEALTH PLAN ID
PA0877346000OtherKHPE ID
PAP11043237OtherMULTIPLAN ID
PASH164898Medicare ID - Type Unspecified
PAP11043237OtherMULTIPLAN ID