Provider Demographics
NPI:1437300985
Name:BRIAN C. SHANE, INC.
Entity Type:Organization
Organization Name:BRIAN C. SHANE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SHANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-336-8316
Mailing Address - Street 1:922 SE FRANK PHILLIPS BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-4230
Mailing Address - Country:US
Mailing Address - Phone:918-336-8316
Mailing Address - Fax:918-336-8780
Practice Address - Street 1:922 SE FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-4230
Practice Address - Country:US
Practice Address - Phone:918-336-8316
Practice Address - Fax:918-336-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty