Provider Demographics
NPI:1376628297
Name:JAVERSAK, SHAYNE ANDREW (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:SHAYNE
Middle Name:ANDREW
Last Name:JAVERSAK
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 WADE WATTS AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501
Mailing Address - Country:US
Mailing Address - Phone:918-423-1873
Mailing Address - Fax:877-310-9896
Practice Address - Street 1:1501 WADE WATTS AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501
Practice Address - Country:US
Practice Address - Phone:918-423-1873
Practice Address - Fax:877-310-9896
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor