Provider Demographics
NPI:1801808431
Name:SHANNAN, GEORGE MARTIN (DC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MARTIN
Last Name:SHANNAN
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 1:6507 W COURTYARD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-4922
Mailing Address - Country:US
Mailing Address - Phone:512-452-9469
Mailing Address - Fax:512-452-7283
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:512-452-7283
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85951GOtherBLUECROSS BLUESHEILD
TX85951GOtherBLUECROSS BLUESHEILD
TXT15853Medicare UPIN