Provider Demographics
NPI:1215085477
Name:AMIN, SHADI (DC)
Entity type:Individual
Prefix:DR
First Name:SHADI
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 S BRISTOL ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7300
Mailing Address - Country:US
Mailing Address - Phone:714-429-0566
Mailing Address - Fax:714-429-0567
Practice Address - Street 1:3620 S BRISTOL ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7300
Practice Address - Country:US
Practice Address - Phone:714-429-0566
Practice Address - Fax:714-429-0567
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960327111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health