Provider Demographics
NPI:1063573269
Name:DOERRFELD, SHAWN DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:DANIEL
Last Name:DOERRFELD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LEANNI WAY UNIT D1
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4756
Mailing Address - Country:US
Mailing Address - Phone:389-986-1966
Mailing Address - Fax:
Practice Address - Street 1:50 LEANNI WAY UNIT D1
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4756
Practice Address - Country:US
Practice Address - Phone:389-986-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-9269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AE372OtherMEDICARE PTAN