Provider Demographics
NPI:1346267069
Name:SHAY, SUZANNE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE
Last Name:SHAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16923 96TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1937
Mailing Address - Country:US
Mailing Address - Phone:425-485-7507
Mailing Address - Fax:425-483-7332
Practice Address - Street 1:16923 96TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1937
Practice Address - Country:US
Practice Address - Phone:425-485-7507
Practice Address - Fax:425-483-7332
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH3337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU63531Medicare UPIN