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General NPI Number Information
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NPI Number | 1871882464
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Entity Type | Organization
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Legal Business Name | SHEPHERD CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 05/27/2011
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Provider Practice Location Address
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Address Line | 665 TERRYVILLE AVE 1ST FLOOR
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City | BRISTOL
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State | CT
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Zip | 06010-4078
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Country | US
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Telephone | 860-589-1491
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Fax |
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Provider Business Mailing Address
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Address Line | 21 UPSON PL
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City | CHESHIRE
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State | CT
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Zip | 06410-1116
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Country | US
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Telephone | 203-695-1489
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. DAVIA HYACINTH SHEPHERD
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Credential | D.C.
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Telephone | 203-695-1489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 001862
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License Number State | CT
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