Provider Demographics
NPI:1902064041
Name:SHEPPARD, DAN (DC)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:SHEPPARD
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:PO BOX 8316
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-8316
Mailing Address - Country:US
Mailing Address - Phone:949-387-0456
Mailing Address - Fax:
Practice Address - Street 1:1133 CAMELBACK ST
Practice Address - Street 2:BOX 8316
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92658-1200
Practice Address - Country:US
Practice Address - Phone:949-387-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC278612083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine