Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5627 | OR |
NPI | 1194953224 |
---|---|
Provider Name | Shamim Matin |
First Address | Hillsboro, OR 97124-1302 |
Second Address | Hillsboro, OR 97124-1302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 25/09/2015 |