Healthcare Provider Details

I. General information

NPI: 1346232501
Provider Name (Legal Business Name): SHAWN HELMER NORD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 E STATE ST
EAGLE ID
83616-5938
US

IV. Provider business mailing address

PO BOX 310
EAGLE ID
83616-0310
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-9195
  • Fax: 208-939-4686
Mailing address:
  • Phone: 208-939-9195
  • Fax: 208-939-4686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberC561
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: