Provider Demographics
NPI:1275722639
Name:CARNAHAN, SHANE PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:PATRICK
Last Name:CARNAHAN
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 1:745 N GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3151
Mailing Address - Country:US
Mailing Address - Phone:509-332-5613
Mailing Address - Fax:509-332-7901
Practice Address - Street 1:745 N GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-3151
Practice Address - Country:US
Practice Address - Phone:509-332-5613
Practice Address - Fax:509-332-7901
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor