Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2017031985 | MO |
NPI | 1003335175 |
---|---|
Provider Name | Shawn Patton |
First Address | Eureka, MO 63025-1109 |
Second Address | Eureka, MO 63025-1109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2017 |
Last Update Date | 11/09/2017 |