Provider Demographics
NPI:1295703106
Name:NEVILLE, SHAWN PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:PATRICK
Last Name:NEVILLE
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 1:11750 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2907
Mailing Address - Country:US
Mailing Address - Phone:301-645-7770
Mailing Address - Fax:301-705-8884
Practice Address - Street 1:11750 BUSINESS PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2907
Practice Address - Country:US
Practice Address - Phone:301-645-7770
Practice Address - Fax:301-705-8884
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD451QMedicare ID - Type Unspecified
MDU01872Medicare UPIN