Provider Demographics
NPI:1609118371
Name:CLURE, SHAYNE DAVID ADAM (LMT)
Entity Type:Individual
Prefix:MR
First Name:SHAYNE
Middle Name:DAVID ADAM
Last Name:CLURE
Suffix:
Gender:M
Credentials:LMT
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 9277
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87119-9277
Mailing Address - Country:US
Mailing Address - Phone:505-459-8528
Mailing Address - Fax:
Practice Address - Street 1:2620 SAN MATEO BLVD NE
Practice Address - Street 2:SUITE F
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3165
Practice Address - Country:US
Practice Address - Phone:505-888-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4983225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist