Healthcare Provider Details

I. General information

NPI: 1750189767
Provider Name (Legal Business Name): SHAHIRA HAIDARY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 E 11TH ST
TRACY CA
95376-4015
US

IV. Provider business mailing address

3146 MULHOLLAND DR
LATHROP CA
95330-7124
US

V. Phone/Fax

Practice location:
  • Phone: 209-740-1649
  • Fax:
Mailing address:
  • Phone: 209-740-1649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC37228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: