Provider Demographics
NPI:1225085293
Name:SHAWHAN, BRUCE C (DC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:C
Last Name:SHAWHAN
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 1:3805 B SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1644
Mailing Address - Country:US
Mailing Address - Phone:262-687-8322
Mailing Address - Fax:262-687-6107
Practice Address - Street 1:3805 B SPRING STREET
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-1644
Practice Address - Country:US
Practice Address - Phone:262-560-0090
Practice Address - Fax:262-687-6107
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391846294018OtherBLUE CROSS
WI000070952Medicare PIN
U53656Medicare UPIN