Provider Demographics
NPI:1962863829
Name:GOLDAY, SHANE THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:THOMAS
Last Name:GOLDAY
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 1:625 N WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4241
Mailing Address - Country:US
Mailing Address - Phone:941-363-1897
Mailing Address - Fax:941-951-1808
Practice Address - Street 1:625 N WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4241
Practice Address - Country:US
Practice Address - Phone:941-363-1897
Practice Address - Fax:941-951-1808
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor