Provider Demographics
NPI:1336649110
Name:CARARAS, SHAINE (DC, PHD, LMT)
Entity Type:Individual
Prefix:
First Name:SHAINE
Middle Name:
Last Name:CARARAS
Suffix:
Gender:M
Credentials:DC, PHD, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 FREEDOM WAY
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-1321
Mailing Address - Country:US
Mailing Address - Phone:504-432-1525
Mailing Address - Fax:
Practice Address - Street 1:722 S. BOIS D'ARC
Practice Address - Street 2:SUITE 9
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:430-435-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-18
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT125226225700000X
TX15569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist