Provider Demographics
NPI:1831342229
Name:SHANAHAN, MICHAEL J (DC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:SHANAHAN
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 1:19750 STATE HIGHWAY 46 W STE 102
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6881
Mailing Address - Country:US
Mailing Address - Phone:830-438-6689
Mailing Address - Fax:830-438-6691
Practice Address - Street 1:19750 STATE HIGHWAY 46 W STE 102
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6881
Practice Address - Country:US
Practice Address - Phone:830-438-6689
Practice Address - Fax:830-438-6691
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor