Provider Demographics
NPI:1467511220
Name:SHANI, SHAY (DC)
Entity type:Individual
Prefix:DR
First Name:SHAY
Middle Name:
Last Name:SHANI
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 1:55 ROLLING OAKS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1010
Mailing Address - Country:US
Mailing Address - Phone:805-494-9977
Mailing Address - Fax:805-494-8558
Practice Address - Street 1:960 S WESTLAKE BLVD STE 14
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3169
Practice Address - Country:US
Practice Address - Phone:805-494-9977
Practice Address - Fax:805-494-8558
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28737OtherCHIROPRACTIC LICENSE