Provider Demographics
NPI:1922142157
Name:SHAMPINE, ROBIN D (DC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:D
Last Name:SHAMPINE
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 1:3901 NE 4TH ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-4100
Mailing Address - Country:US
Mailing Address - Phone:425-277-0577
Mailing Address - Fax:425-277-0652
Practice Address - Street 1:3901 NE 4TH ST
Practice Address - Street 2:SUITE 109
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4100
Practice Address - Country:US
Practice Address - Phone:425-277-0577
Practice Address - Fax:425-277-0652
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8800608Medicare PIN