Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 08002569A | IN |
NPI | 1003108192 |
---|---|
Provider Name | Mrs. Shanna Gail Dudash |
First Address | La Porte, IN 46350-7895 |
Second Address | La Porte, IN 46350-4946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2011 |
Last Update Date | 22/06/2016 |