Provider Demographics
NPI:1285042515
Name:HENRY, SHANE (DC)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:HENRY
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 1:826 FOCIS ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2200
Mailing Address - Country:US
Mailing Address - Phone:504-456-8560
Mailing Address - Fax:504-456-8562
Practice Address - Street 1:826 FOCIS ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2200
Practice Address - Country:US
Practice Address - Phone:504-456-8560
Practice Address - Fax:504-456-8562
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1676111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation