Healthcare Provider Details

I. General information

NPI: 1760319750
Provider Name (Legal Business Name): SHAI SHAASHUA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 E THOMAS RD
PHOENIX AZ
85016-7602
US

IV. Provider business mailing address

4810 E NISBET RD
SCOTTSDALE AZ
85254-2249
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-4247
  • Fax:
Mailing address:
  • Phone: 480-269-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number009529
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: