Provider Demographics
NPI:1912009721
Name:TRAHIN, MICHAEL SHANE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHANE
Last Name:TRAHIN
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 1:1510 WINCHESTER HWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2708
Mailing Address - Country:US
Mailing Address - Phone:931-438-4499
Mailing Address - Fax:931-438-4487
Practice Address - Street 1:1510 WINCHESTER HWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2708
Practice Address - Country:US
Practice Address - Phone:931-438-4499
Practice Address - Fax:931-438-4487
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3002129OtherBCBS
U50221Medicare UPIN
3677612Medicare ID - Type Unspecified