Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4205-012 | WI |
N | 111NN1001X | Nutrition | 4205-012 | WI |
N | 111NP0017X | Pediatric Chiropractor | 4205-12 | WI |
NPI | 1639342173 |
---|---|
Provider Name | Shae A Doran |
First Address | Appleton, WI 54913 |
Second Address | Appleton, WI 54913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2008 |
Last Update Date | 25/02/2021 |