Provider Demographics
NPI:1306967047
Name:SHPAK, MICHAEL SIMEON (LAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SIMEON
Last Name:SHPAK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 SNYDER CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-4445
Mailing Address - Country:US
Mailing Address - Phone:925-945-7018
Mailing Address - Fax:
Practice Address - Street 1:1916 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4602
Practice Address - Country:US
Practice Address - Phone:925-926-0499
Practice Address - Fax:925-926-0491
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4185111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition