Provider Demographics
NPI:1982602389
Name:ESPINOZA, SHANE E (DC CCSP)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:E
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10355 NW GLENCOE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH PLAINS
Mailing Address - State:OR
Mailing Address - Zip Code:97133-8244
Mailing Address - Country:US
Mailing Address - Phone:503-647-9944
Mailing Address - Fax:503-447-5011
Practice Address - Street 1:10355 NW GLENCOE RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH PLAINS
Practice Address - State:OR
Practice Address - Zip Code:97133-8244
Practice Address - Country:US
Practice Address - Phone:503-647-9944
Practice Address - Fax:503-447-5011
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2009-11-12
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
OR3450111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor