MEDICARE: DR. SHAWN ALLEN COTTRELL DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	671	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023117587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAWN ALLEN COTTRELL DC

Provider Business Mailing Address
First Line	:	127 GOFF MOUNTAIN RD
Second Line	:
City	:	CROSS LANES
State	:	WV
Zip	:	25313-1434
Country	:	US
Telephone Number	:	304-776-7290
Fax Number	:	304-776-8058

Provider Business Practice Location Address
First Line	:	127 GOFF MOUNTAIN RD
Second Line	:
City	:	CROSS LANES
State	:	WV
Zip	:	25313-1434
Country	:	US
Telephone Number	:	304-776-7290
Fax Number	:	304-776-8058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	10/05/2021

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Directions to “ DR. SHAWN ALLEN COTTRELL DC” Practice Location

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