Provider Demographics
NPI:1770122970
Name:WERNKE, SHANE ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:ANTHONY
Last Name:WERNKE
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 1:3717 S GRANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6329
Mailing Address - Country:US
Mailing Address - Phone:605-782-9871
Mailing Address - Fax:
Practice Address - Street 1:3717 S GRANGE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6329
Practice Address - Country:US
Practice Address - Phone:605-782-9871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1363OtherSTATE LICENSE NUMBER