Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 8742 | TX |
NPI | 1083804355 |
---|---|
Provider Name | Dr. Nicole Marie Shutko |
First Address | Houston, TX 77098-4120 |
Second Address | Houston, TX 77098-4120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 17/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8AK973 | BCBS (01) | TX |