Healthcare Provider Details

I. General information

NPI: 1598760621
Provider Name (Legal Business Name): MICHAEL S SHORE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29525 CANWOOD ST STE 204
AGOURA HILLS CA
91301-4231
US

IV. Provider business mailing address

29525 CANWOOD ST STE 204
AGOURA HILLS CA
91301-4231
US

V. Phone/Fax

Practice location:
  • Phone: 818-991-3900
  • Fax: 818-991-4039
Mailing address:
  • Phone: 818-991-3900
  • Fax: 818-991-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC19987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: