Provider Demographics
NPI:1952950776
Name:HASHEM, SHIVA (DC)
Entity Type:Individual
Prefix:
First Name:SHIVA
Middle Name:
Last Name:HASHEM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 S MAIN AVE STE D
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3352
Mailing Address - Country:US
Mailing Address - Phone:760-779-2400
Mailing Address - Fax:
Practice Address - Street 1:746 S MAIN AVE STE D
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3352
Practice Address - Country:US
Practice Address - Phone:760-779-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26269OtherSTATE LICENSE