Provider Demographics
NPI:1013079201
Name:SHUMAN, DEREK ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ALAN
Last Name:SHUMAN
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 1:106 S HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4234
Mailing Address - Country:US
Mailing Address - Phone:951-929-1907
Mailing Address - Fax:951-929-2027
Practice Address - Street 1:106 S HARVARD ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4234
Practice Address - Country:US
Practice Address - Phone:951-929-1907
Practice Address - Fax:951-929-2027
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0228540Medicare ID - Type Unspecified