Healthcare Provider Details

I. General information

NPI: 1225385719
Provider Name (Legal Business Name): SHAWN C BORGES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 FOUNTAIN AVE
PACIFIC GROVE CA
93950-4309
US

IV. Provider business mailing address

630 FOUNTAIN AVE
PACIFIC GROVE CA
93950-4309
US

V. Phone/Fax

Practice location:
  • Phone: 831-373-1003
  • Fax: 831-373-1024
Mailing address:
  • Phone: 831-373-1003
  • Fax: 831-373-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: