Provider Demographics
NPI:1912603895
Name:SHAUL, COLIN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:DAVID
Last Name:SHAUL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:
Other - Last Name:SHAUL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:25603 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-3305
Mailing Address - Country:US
Mailing Address - Phone:503-492-6851
Mailing Address - Fax:
Practice Address - Street 1:25603 SE STARK ST
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-3305
Practice Address - Country:US
Practice Address - Phone:503-492-6851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor