Provider Demographics
NPI:1134277353
Name:SHIRER, MELVIN LLOYD (DC)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:LLOYD
Last Name:SHIRER
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 1:5995 BROCKTON AVE
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1867
Mailing Address - Country:US
Mailing Address - Phone:951-787-8222
Mailing Address - Fax:951-789-4378
Practice Address - Street 1:5995 BROCKTON AVE
Practice Address - Street 2:SUITE C-1
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1867
Practice Address - Country:US
Practice Address - Phone:951-787-8222
Practice Address - Fax:951-789-4378
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 19604111N00000X
UT292082-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor