Provider Demographics
NPI:1043218969
Name:NEWMAN, SHANLYN MARIE (DC)
Entity Type:Individual
Prefix:
First Name:SHANLYN
Middle Name:MARIE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 W 3RD PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6578
Mailing Address - Country:US
Mailing Address - Phone:480-835-1174
Mailing Address - Fax:480-835-1130
Practice Address - Street 1:266 W 3RD PL
Practice Address - Street 2:SUITE 1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6578
Practice Address - Country:US
Practice Address - Phone:480-835-1174
Practice Address - Fax:480-835-1130
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor