Provider Demographics
NPI:1750189767
Name:HAIDARY, SHAHIRA (DC)
Entity type:Individual
Prefix:
First Name:SHAHIRA
Middle Name:
Last Name:HAIDARY
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3146 MULHOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-7124
Mailing Address - Country:US
Mailing Address - Phone:209-740-1649
Mailing Address - Fax:
Practice Address - Street 1:227 E 11TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4015
Practice Address - Country:US
Practice Address - Phone:209-740-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC37228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor