Provider Demographics
NPI:1366544587
Name:SHEPHERD, ROBERT C (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:SHEPHERD
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 1:2415 HENNEPIN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409
Mailing Address - Country:US
Mailing Address - Phone:612-872-9133
Mailing Address - Fax:612-872-0342
Practice Address - Street 1:2415 HENNEPIN AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409
Practice Address - Country:US
Practice Address - Phone:612-872-9133
Practice Address - Fax:612-872-0342
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU30730Medicare UPIN