Provider Demographics
NPI:1184702243
Name:SHANE, ROBERT JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:SHANE
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 1:315 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13209-1555
Mailing Address - Country:US
Mailing Address - Phone:315-487-2225
Mailing Address - Fax:315-487-2225
Practice Address - Street 1:315 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13209-1555
Practice Address - Country:US
Practice Address - Phone:315-487-2225
Practice Address - Fax:315-487-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004756-1111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health