Provider Demographics
NPI:1215014782
Name:TIAN, SHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAN
Middle Name:
Last Name:TIAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 SHANNON CIR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35904-3249
Mailing Address - Country:US
Mailing Address - Phone:256-543-3967
Mailing Address - Fax:
Practice Address - Street 1:2007 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5507
Practice Address - Country:US
Practice Address - Phone:256-543-0009
Practice Address - Fax:256-549-1221
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-21733OtherBCBS PIN
AL515-21733OtherBCBS PIN