Provider Demographics
NPI:1548800337
Name:MAHANEY, SHELBY ANNE (DC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ANNE
Last Name:MAHANEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12521 LIGHTHOUSE WAY DR APT E
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5409
Mailing Address - Country:US
Mailing Address - Phone:317-752-5694
Mailing Address - Fax:
Practice Address - Street 1:914 HEMSATH RD STE 104A
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6582
Practice Address - Country:US
Practice Address - Phone:636-724-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019047630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor