Provider Demographics
NPI:1578591566
Name:GAY, SHAWN LEON (DC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:LEON
Last Name:GAY
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 1:20218 77TH AVE NE
Mailing Address - Street 2:STE. A
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-4603
Mailing Address - Country:US
Mailing Address - Phone:360-435-3900
Mailing Address - Fax:360-435-3900
Practice Address - Street 1:20218 77TH AVE NE
Practice Address - Street 2:STE. A
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-4602
Practice Address - Country:US
Practice Address - Phone:360-435-3900
Practice Address - Fax:360-435-1105
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2542GAOtherREGENCDE PIN
WA8808733Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
WA8808731Medicare ID - Type UnspecifiedMEDICARE GROUP