Provider Demographics
NPI:1285777391
Name:HADDAD, SHIHAB SAMUEL (DC)
Entity type:Individual
Prefix:
First Name:SHIHAB
Middle Name:SAMUEL
Last Name:HADDAD
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 1:42212 10TH ST W
Mailing Address - Street 2:STE 10A
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7001
Mailing Address - Country:US
Mailing Address - Phone:661-942-9100
Mailing Address - Fax:661-942-9191
Practice Address - Street 1:42212 10TH ST W
Practice Address - Street 2:STE 10A
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7001
Practice Address - Country:US
Practice Address - Phone:818-716-9924
Practice Address - Fax:818-716-0017
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0280770Medicaid
CADC28077Medicare ID - Type Unspecified
CADC0280770Medicaid