Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 3910 | OR |
NPI | 1043400823 |
---|---|
Provider Name | Dr. Shawn Scott Hatch |
First Address | Vancouver, WA 98665-0024 |
Second Address | Portland, OR 97230-3014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2007 |
Last Update Date | 27/07/2011 |