Provider Demographics
NPI:1205061801
Name:SHAH, AMI (DC)
Entity type:Individual
Prefix:DR
First Name:AMI
Middle Name:
Last Name:SHAH
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 1:132 WESTPORT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:714-803-1611
Mailing Address - Fax:
Practice Address - Street 1:2755 BRISTOL ST
Practice Address - Street 2:# 120
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5985
Practice Address - Country:US
Practice Address - Phone:949-631-5050
Practice Address - Fax:949-631-5052
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor