Individual
DR. SHANE A STAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
323 EAST MAIN STREET, WEST BRANCH, IA 52358
(319) 643-5194
Mailing address
P.O. BOX 459, WEST BRANCH, IA 52358
(319) 643-5194
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
06621
IA
111N00000X
Chiropractor
DC28913
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0473165
—
IA
Enumeration date
10/03/2006
Last updated
07/08/2007
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