Provider Demographics
NPI:1013129022
Name:RICE, SHAWN CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:CHARLES
Last Name:RICE
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 1:3306 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-3034
Mailing Address - Country:US
Mailing Address - Phone:334-699-3362
Mailing Address - Fax:866-910-2391
Practice Address - Street 1:418 S PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2208
Practice Address - Country:US
Practice Address - Phone:205-863-9335
Practice Address - Fax:866-910-2391
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-10674OtherBCBS