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General NPI Number Information
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NPI Number | 1003309667
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Entity Type | Individual
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Provider Name | SHAWN ROBERTSON L.AC
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Gender | Male
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 1001 SW HIGGINS AVE STE 104
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City | MISSOULA
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State | MT
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Zip | 59803-1340
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Country | US
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Telephone | 406-540-0081
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Fax | 406-284-0678
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Provider Business Mailing Address
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Address Line | 1001 SW HIGGINS AVE STE 104
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City | MISSOULA
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State | MT
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Zip | 59803-1340
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Country | US
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Telephone | 406-540-0081
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Fax | 406-284-0678
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | MED-ACU-LIC-67145
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License Number State | MT
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