Provider Demographics
NPI:1447571443
Name:MCCRAE, SHAUN ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:ALEXANDER
Last Name:MCCRAE
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 LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8478
Mailing Address - Country:US
Mailing Address - Phone:713-873-1166
Mailing Address - Fax:
Practice Address - Street 1:745 LAKE TRL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8478
Practice Address - Country:US
Practice Address - Phone:713-873-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04446111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician