Provider Demographics
NPI:1700893161
Name:SHAFFER, DAVID C (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:SHAFFER
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 1:7065 INDIANA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4167
Mailing Address - Country:US
Mailing Address - Phone:951-476-0115
Mailing Address - Fax:703-738-7499
Practice Address - Street 1:7065 INDIANA AVE STE 110
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4167
Practice Address - Country:US
Practice Address - Phone:951-476-0115
Practice Address - Fax:951-476-0116
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104556356OtherVIRGINIA STATE LICENSE #