Provider Demographics
NPI:1255572517
Name:SHANLEY, JOHN JR (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SHANLEY
Suffix:JR
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 1:115 MARION PL
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3456
Mailing Address - Country:US
Mailing Address - Phone:740-512-9763
Mailing Address - Fax:
Practice Address - Street 1:450 MAIN ST
Practice Address - Street 2:B
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3770
Practice Address - Country:US
Practice Address - Phone:740-512-9763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor