Provider Demographics
NPI:1962955245
Name:SHEPHERD, ANDREW CLARK (DC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CLARK
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 1:11187 CAUTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-1648
Mailing Address - Country:US
Mailing Address - Phone:757-810-8360
Mailing Address - Fax:
Practice Address - Street 1:3 S 12TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-4096
Practice Address - Country:US
Practice Address - Phone:804-726-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor