Provider Demographics
NPI:1932450228
Name:SHEPPARD, IAN DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:DOUGLAS
Last Name:SHEPPARD
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 1:243 SW SCALEHOUSE LOOP STE 1A
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1278
Mailing Address - Country:US
Mailing Address - Phone:541-213-2190
Mailing Address - Fax:541-213-2649
Practice Address - Street 1:243 SW SCALEHOUSE LOOP STE 1A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1278
Practice Address - Country:US
Practice Address - Phone:541-213-2190
Practice Address - Fax:541-213-2649
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor