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General NPI Number Information
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NPI Number | 1124015532
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Entity Type | Individual
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Provider Name | J. CHRISTOPHER SHANK M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 151 E BOW ST
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City | THORNTOWN
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State | IN
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Zip | 46071-1164
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Country | US
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Telephone | 765-436-2400
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Fax | 765-436-7375
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Provider Business Mailing Address
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Address Line | 2705 N LEBANON ST STE 305
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City | LEBANON
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State | IN
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Zip | 46052-8622
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Country | US
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Telephone | 765-485-8852
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Fax | 765-485-8669
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01046198
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License Number State | IN
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