Provider Demographics
NPI:1376505818
Name:STUBBS, SHAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:STUBBS
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 1:2826 MOODY PKWY
Mailing Address - Street 2:STE A
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3101
Mailing Address - Country:US
Mailing Address - Phone:205-640-6500
Mailing Address - Fax:205-640-7073
Practice Address - Street 1:2826 MOODY PKWY
Practice Address - Street 2:STE A
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3101
Practice Address - Country:US
Practice Address - Phone:205-640-6500
Practice Address - Fax:205-640-7073
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL1449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-75104OtherBCBS OF AL
ALU37030Medicare UPIN