Individual
MR. SHANE C. WIBEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
900 STATE ST, WILLAMETTE UNIVERSITY ATHLETICS, SALEM, OR 97301-3922
(503) 370-6672
Mailing address
900 STATE ST, WILLAMETTE UNIVERSITY ATHLETICS, SALEM, OR 97301-3922
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
055276
OR
Other
Enumeration date
09/27/2006
Last updated
07/08/2007
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