Provider Demographics
NPI:1871679324
Name:HANCOCK, SHANE JEFFERY (DC)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:JEFFERY
Last Name:HANCOCK
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 1:3930 LOUETTA RD STE A
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4565
Mailing Address - Country:US
Mailing Address - Phone:281-528-9177
Mailing Address - Fax:281-528-9545
Practice Address - Street 1:3930 LOUETTA RD
Practice Address - Street 2:A
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4565
Practice Address - Country:US
Practice Address - Phone:281-528-9177
Practice Address - Fax:281-528-9545
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8353OtherSTATE LICENSE
TXTXB164537Medicare PIN