Healthcare Provider Details

I. General information

NPI: 1285042515
Provider Name (Legal Business Name): SHANE HENRY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 FOCIS ST
METAIRIE LA
70005-2200
US

IV. Provider business mailing address

826 FOCIS ST
METAIRIE LA
70005-2200
US

V. Phone/Fax

Practice location:
  • Phone: 504-456-8560
  • Fax: 504-456-8562
Mailing address:
  • Phone: 504-456-8560
  • Fax: 504-456-8562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1676
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1676
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: