Provider Demographics
NPI:1487060596
Name:SHAH, SUPREET (DC)
Entity type:Individual
Prefix:
First Name:SUPREET
Middle Name:
Last Name:SHAH
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 1:150 LOMBARD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-1169
Mailing Address - Country:US
Mailing Address - Phone:415-421-1115
Mailing Address - Fax:415-421-1116
Practice Address - Street 1:150 LOMBARD ST STE 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-1169
Practice Address - Country:US
Practice Address - Phone:415-421-1115
Practice Address - Fax:415-421-1116
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor