Provider Demographics
NPI:1558596205
Name:SHAUN DOLL CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:SHAUN DOLL CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-420-9169
Mailing Address - Street 1:PO BOX 12573
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-0573
Mailing Address - Country:US
Mailing Address - Phone:503-566-8456
Mailing Address - Fax:
Practice Address - Street 1:2794 12TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3159
Practice Address - Country:US
Practice Address - Phone:503-566-8456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty