Provider Demographics
NPI:1235688839
Name:SHINKLE, PAUL (LAC, MSOM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:SHINKLE
Suffix:
Gender:M
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10827 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1127
Mailing Address - Country:US
Mailing Address - Phone:414-209-4228
Mailing Address - Fax:
Practice Address - Street 1:10827 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1127
Practice Address - Country:US
Practice Address - Phone:414-209-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI913-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist