Provider Demographics
NPI:1811160864
Name:SHANKS, CALVIN (DC)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:SHANKS
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 1:2731 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3855
Mailing Address - Country:US
Mailing Address - Phone:270-444-7111
Mailing Address - Fax:270-444-7122
Practice Address - Street 1:2731 JACKSON ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3855
Practice Address - Country:US
Practice Address - Phone:270-444-7111
Practice Address - Fax:270-444-7122
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U87001Medicare UPIN