Provider Demographics
NPI:1851458970
Name:SHANKS, MICHAEL KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KEVIN
Last Name:SHANKS
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 1:813 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9315
Mailing Address - Country:US
Mailing Address - Phone:417-725-8550
Mailing Address - Fax:417-725-8553
Practice Address - Street 1:813 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9315
Practice Address - Country:US
Practice Address - Phone:417-725-8550
Practice Address - Fax:417-725-8553
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004008978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor