MEDICARE: DOC ROBIN D PS

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

General Provider Information

NPI Number	:	1386631877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOC ROBIN D PS

Provider Business Mailing Address
First Line	:	3901 NE 4TH ST
Second Line	:	SUITE 109
City	:	RENTON
State	:	WA
Zip	:	98056-4100
Country	:	US
Telephone Number	:	425-277-0577
Fax Number	:	425-277-0652

Provider Business Practice Location Address
First Line	:	3901 NE 4TH ST
Second Line	:	SUITE 109
City	:	RENTON
State	:	WA
Zip	:	98056-4100
Country	:	US
Telephone Number	:	425-277-0577
Fax Number	:	425-277-0652

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBIN D SHAMPINE
Credential	:	D.C.
Telephone Number	:	425-277-0577

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	07/25/2007

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