MEDICARE: DR. SHANE EVAN ISDALE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	10153	TX

General Provider Information

NPI Number	:	1215951777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANE EVAN ISDALE D.C.

Provider Business Mailing Address
First Line	:	716 INDIAN TRL
Second Line	:	SUITE 120
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-5700
Country	:	US
Telephone Number	:	254-698-1600
Fax Number	:	254-698-1605

Provider Business Practice Location Address
First Line	:	716 INDIAN TRL
Second Line	:	SUITE 120
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-5700
Country	:	US
Telephone Number	:	254-698-1600
Fax Number	:	254-698-1605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	08/03/2011

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Directions to “ DR. SHANE EVAN ISDALE D.C.” Practice Location

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