Provider Demographics
NPI:1972536423
Name:SHUMWAY, KRISTYN E (DC)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:E
Last Name:SHUMWAY
Suffix:
Gender:F
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:PO BOX 1962
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-1962
Mailing Address - Country:US
Mailing Address - Phone:970-708-0224
Mailing Address - Fax:
Practice Address - Street 1:210 ALDER ST.
Practice Address - Street 2:
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-708-0224
Practice Address - Fax:866-277-0269
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6102111N00000X
AZ5747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4858OtherMEDICARE PTAN