Provider Demographics
NPI:1124217385
Name:SHACKLETON, CHRISTOPHER R (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:SHACKLETON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:BC
Mailing Address - Zip Code:V6J3V2
Mailing Address - Country:CA
Mailing Address - Phone:604-731-1669
Mailing Address - Fax:
Practice Address - Street 1:3290 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:BC
Practice Address - Zip Code:V6J3V2
Practice Address - Country:CA
Practice Address - Phone:604-731-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48676204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery