Provider Demographics
NPI:1952369357
Name:EGAN, SHAWN TIMOTHY (DC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:TIMOTHY
Last Name:EGAN
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 1:1310 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5300
Mailing Address - Country:US
Mailing Address - Phone:321-254-3630
Mailing Address - Fax:321-242-8176
Practice Address - Street 1:1310 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5300
Practice Address - Country:US
Practice Address - Phone:321-254-3630
Practice Address - Fax:321-242-8176
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38003440Medicaid
FL70718Medicare ID - Type Unspecified
FL38003440Medicaid