Provider Demographics
NPI:1801022199
Name:KIDD, SHAWN THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:THOMAS
Last Name:KIDD
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 1:613 WESTLAKE ST STE 125A
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3866
Mailing Address - Country:US
Mailing Address - Phone:760-230-1228
Mailing Address - Fax:
Practice Address - Street 1:613 WESTLAKE ST STE 125A
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3866
Practice Address - Country:US
Practice Address - Phone:760-230-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 31281111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician