Provider Demographics
NPI:1164809109
Name:CHAVEZ, SHAWN (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5278 W ELLENS FERRY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3152
Mailing Address - Country:US
Mailing Address - Phone:208-861-4532
Mailing Address - Fax:
Practice Address - Street 1:910 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1308
Practice Address - Country:US
Practice Address - Phone:208-377-3777
Practice Address - Fax:208-377-3779
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG-489225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist