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General NPI Number Information
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NPI Number | 1316154396
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Entity Type | Individual
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Provider Name | DWIGHT A SHANEYFELT DC,CCN,DACBN
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2001 BRIDGEWAY
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City | SAUSALITO
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State | CA
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Zip | 94965-1736
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Country | US
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Telephone | 415-332-4304
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Fax | 415-332-6055
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Provider Business Mailing Address
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Address Line | 2001 BRIDGEWAY
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City | SAUSALITO
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State | CA
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Zip | 94965-1736
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Country | US
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Telephone | 415-332-4304
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Fax | 415-332-6055
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | DC20784
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License Number State | CA
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