Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 007661 | IA |
Y | 111NP0017X | Pediatric Chiropractor | 007661 | IA |
NPI | 1487194288 |
---|---|
Provider Name | Dr. Nicole Shabino |
First Address | Des Moines, IA 50312-3929 |
Second Address | Des Moines, IA 50312-3929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2017 |
Last Update Date | 28/02/2017 |