Provider Demographics
NPI:1669421376
Name:SHEARER, KEVIN DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DOUGLAS
Last Name:SHEARER
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 1:17720 SE MILL PLAIN BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-7583
Mailing Address - Country:US
Mailing Address - Phone:360-944-4437
Mailing Address - Fax:
Practice Address - Street 1:17720 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-7583
Practice Address - Country:US
Practice Address - Phone:360-944-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKS8927111N00000X
WACH00034737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-0-C3-1317-0OtherBCBS
MIP017900006Medicare ID - Type Unspecified
MIV064663Medicare UPIN