Provider Demographics
NPI:1184692907
Name:SHAMSBOD, TINA (DC)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:SHAMSBOD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18110 FLYNN DR
Mailing Address - Street 2:#4201
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-4952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2501 E PALMDALE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-1346
Practice Address - Country:US
Practice Address - Phone:661-274-8725
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV06818Medicare UPIN
CAWDC29640AMedicare ID - Type UnspecifiedMEDICARE MEMBER ID