Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 1534 | SC |
Y | 111NS0005X | Chiropractic Sports Physician | 1839 | NC |
NPI | 1255347282 |
---|---|
Provider Name | Dr. Eric Scott Shook |
First Address | Newton, NC 28658-3757 |
Second Address | Newton, NC 28658-3757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 30/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0878B | BLUE CROSS BLUE SHIELD (01) | NC |
U31199 | (02) | NC |