Provider Demographics
NPI:1659879807
Name:MEDLEY, SHAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:MEDLEY
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 1:1160 S EUCALYPTUS PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1237
Mailing Address - Country:US
Mailing Address - Phone:520-591-8701
Mailing Address - Fax:
Practice Address - Street 1:15615 N ORACLE RD STE 135
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-9121
Practice Address - Country:US
Practice Address - Phone:520-818-3774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor