Provider Demographics
NPI:1265489520
Name:BISSON, SHANE DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:DEAN
Last Name:BISSON
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 1:12256 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1256
Mailing Address - Country:US
Mailing Address - Phone:913-345-9888
Mailing Address - Fax:913-345-0958
Practice Address - Street 1:12256 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1256
Practice Address - Country:US
Practice Address - Phone:913-345-9888
Practice Address - Fax:913-345-0958
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS31615016OtherBCBS
KS125178OtherCOVENTRY
KS7303408OtherAETNA
KSU94491Medicare UPIN
KSN80C303Medicare ID - Type Unspecified