Provider Demographics
NPI:1346232501
Name:NORD, SHAWN HELMER (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:HELMER
Last Name:NORD
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:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-0310
Mailing Address - Country:US
Mailing Address - Phone:208-939-9195
Mailing Address - Fax:208-939-4686
Practice Address - Street 1:589 E STATE ST
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5938
Practice Address - Country:US
Practice Address - Phone:208-939-9195
Practice Address - Fax:208-939-4686
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDT81759Medicare UPIN
ID1672284Medicare ID - Type Unspecified