Basic Information
| Provider Information | |||||||||
| NPI: | 1861426702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EMAN | ||||||||
| FirstName: | SHAHROUZ | ||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050 S BLOSSER RD | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934587310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053618028 | ||||||||
| FaxNumber: | 8053618097 | ||||||||
| Practice Location | |||||||||
| Address1: | 1057 E GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | ARROYO GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934202504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052701700 | ||||||||
| FaxNumber: | 8054817097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC 27053 | CA | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 1447277488 | 01 | CA | COASTAL MEDICAL CENTER NPI | OTHER | FHC70737F | 01 | CA | MEDICAID-LOS ROBLES MEDICAL CENTER | OTHER | 1124045042 | 01 | CA | LOS ROBLES MEDICAL CENTER NPI | OTHER | 551905 | 01 | CA | LOS ROBLES MED CENTER MEDICARE GROUP | OTHER | 551903 | 01 | CA | MEDICARE UGS COASTAL MEDICAL CENTER | OTHER | W1508 | 01 | CA | MEDICARE GROUP ID LOS ROBLES MEDICAL CENTER | OTHER | W1508 | 01 | CA | COASTAL MEDICAL CENTER MEDICARE GROUP | OTHER | FHC70593F | 05 | CA | MEDICAID |