Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2301010388 | MI |
NPI | 1104284009 |
---|---|
Provider Name | Michael D Shaheen |
First Address | East Lansing, MI 48823-2740 |
Second Address | East Lansing, MI 48823-2740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2016 |
Last Update Date | 21/09/2016 |