Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 4064 | OR |
N | 111N00000X | Chiropractor | CHIR.CH.60226450 | WA |
Y | 111NS0005X | Chiropractic Sports Physician | 4064 | OR |
NPI | 1093012999 |
---|---|
Provider Name | Dr. Shawn Conrad Lutz |
First Address | Bend, OR 97703-7559 |
Second Address | Bend, OR 97703-7559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2011 |
Last Update Date | 17/03/2018 |