Provider Demographics
NPI:1912933227
Name:MCCALL, SHANE A (D C)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:A
Last Name:MCCALL
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21681 N 77TH AVE
Mailing Address - Street 2:SUITE 1415
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2132
Mailing Address - Country:US
Mailing Address - Phone:623-572-9200
Mailing Address - Fax:623-572-9204
Practice Address - Street 1:21681 N 77TH AVE
Practice Address - Street 2:SUITE 1415
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2132
Practice Address - Country:US
Practice Address - Phone:623-572-9200
Practice Address - Fax:623-572-9204
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ71042Medicare UPIN