Provider Demographics
NPI:1093744302
Name:SHANAHAN, KEVIN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:SHANAHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 S BROADWAY ST
Mailing Address - Street 2:P.O. BOX 96
Mailing Address - City:TOLEDO
Mailing Address - State:IA
Mailing Address - Zip Code:52342-2302
Mailing Address - Country:US
Mailing Address - Phone:641-484-3740
Mailing Address - Fax:641-484-5861
Practice Address - Street 1:1004 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IA
Practice Address - Zip Code:52342-2302
Practice Address - Country:US
Practice Address - Phone:641-484-3740
Practice Address - Fax:641-484-5861
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0192948Medicaid
IA03684Medicare UPIN
IA0192948Medicaid