Provider Demographics
NPI:1316154396
Name:SHANEYFELT, DWIGHT A (DC,CCN,DACBN)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:A
Last Name:SHANEYFELT
Suffix:
Gender:M
Credentials:DC,CCN,DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BRIDGEWAY
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1736
Mailing Address - Country:US
Mailing Address - Phone:415-332-4304
Mailing Address - Fax:415-332-6055
Practice Address - Street 1:2001 BRIDGEWAY
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1736
Practice Address - Country:US
Practice Address - Phone:415-332-4304
Practice Address - Fax:415-332-6055
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20784111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition