Healthcare Provider Details

I. General information

NPI: 1194953224
Provider Name (Legal Business Name): SHAMIM MATIN D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1964 NE 49TH WAY
HILLSBORO OR
97124-1302
US

IV. Provider business mailing address

1964 NE 49TH WAY
HILLSBORO OR
97124-1302
US

V. Phone/Fax

Practice location:
  • Phone: 503-858-7845
  • Fax:
Mailing address:
  • Phone: 503-858-7845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5627
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: