MEDICARE: DR. SHAWN ELLIOT SULAK D.N.

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	172P00000X	Naprapath	181000316	IL
2	172P00000X	Naprapath	0022	NM

General Provider Information

NPI Number	:	1649494873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAWN ELLIOT SULAK D.N.

Provider Business Mailing Address
First Line	:	3600 CERRILLOS RD. SUITE 407
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507
Country	:	US
Telephone Number	:	505-424-8990
Fax Number	:	505-424-6377

Provider Business Practice Location Address
First Line	:	3600 CERRILLOS RD STE 407
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2653
Country	:	US
Telephone Number	:	505-424-8990
Fax Number	:	505-424-6377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	03/20/2013

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