Provider Demographics
NPI:1184866204
Name:SHOEMAKER, TRENT M (DC)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:M
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 OAKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3418
Mailing Address - Country:US
Mailing Address - Phone:503-635-4656
Mailing Address - Fax:503-635-4281
Practice Address - Street 1:4309 OAKRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3418
Practice Address - Country:US
Practice Address - Phone:503-635-4656
Practice Address - Fax:503-635-4281
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor