Provider Demographics
NPI:1023131695
Name:SHANAN CHIROPRACTIC
Entity type:Organization
Organization Name:SHANAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GEORGE M. SHANNAN,D.C.
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SHANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPACTOR
Authorized Official - Phone:512-452-9469
Mailing Address - Street 1:5840 BALCONES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4246
Mailing Address - Country:US
Mailing Address - Phone:512-452-9469
Mailing Address - Fax:512-452-4983
Practice Address - Street 1:5840 BALCONES DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4246
Practice Address - Country:US
Practice Address - Phone:512-452-9469
Practice Address - Fax:512-452-4983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2086111N00000X
TX7335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85952GOtherBCBS
TX85951GOtherBCBS
TX85951GOtherBCBS