Provider Demographics
NPI:1740512623
Name:SHOAR-GAVIN CHIROPRACTIC, INC
Entity type:Organization
Organization Name:SHOAR-GAVIN CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-487-4043
Mailing Address - Street 1:132 S A ST STE B
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-5690
Mailing Address - Country:US
Mailing Address - Phone:805-487-4043
Mailing Address - Fax:805-487-4003
Practice Address - Street 1:2653 E VINEYARD AVE
Practice Address - Street 2:#108
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036
Practice Address - Country:US
Practice Address - Phone:805-485-6553
Practice Address - Fax:805-485-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty