Chance Ray Shadwick

NPI #1164120549 in Vinita, Oklahoma

Provider Information

NPI Number: 1164120549
Entity Type: Individual
Name: Chance Ray Shadwick
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Peer Specialist
Enumeration Date: Feb 15, 2023
Last Updated: Feb 15, 2023

Practice Location

Address: 405 E EXCELSIOR AVE
City: Vinita
State: Oklahoma
ZIP Code: 74301-4226
Phone: (918) 864-0706

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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