Provider Demographics
NPI:1326072968
Name:DUGAN, SHAWN GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:GREGORY
Last Name:DUGAN
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 1:8521 E FLORENTINE RD STE D
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8954
Mailing Address - Country:US
Mailing Address - Phone:928-775-9200
Mailing Address - Fax:928-772-9046
Practice Address - Street 1:8521 E FORENTINE DR. STE D
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-775-9200
Practice Address - Fax:928-772-9046
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ69009Medicare ID - Type Unspecified