Healthcare Provider Details

I. General information

NPI: 1912165275
Provider Name (Legal Business Name): SHAWN VIGNEAU D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E WARNER RD SUITE 107
TEMPE AZ
85284-3224
US

IV. Provider business mailing address

PO BOX 2954
PHOENIX AZ
85082-2954
US

V. Phone/Fax

Practice location:
  • Phone: 480-897-3300
  • Fax: 480-897-3312
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7942
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4626
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: