Provider Demographics
NPI:1003519455
Name:ACEY, SHANE RAY (DC)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:RAY
Last Name:ACEY
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 1:1382 YMCA DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2662
Mailing Address - Country:US
Mailing Address - Phone:636-937-7771
Mailing Address - Fax:636-937-7775
Practice Address - Street 1:1382 YMCA DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2662
Practice Address - Country:US
Practice Address - Phone:636-937-7771
Practice Address - Fax:636-937-7775
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008623111N00000X
MO2023015283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor