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General NPI Number Information
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NPI Number | 1154627867
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Entity Type | Organization
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Legal Business Name | SHAWN T. EGAN, PA
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 1310 W EAU GALLIE BLVD STE A
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City | MELBOURNE
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State | FL
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Zip | 32935-5300
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Country | US
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Telephone | 321-254-3630
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Fax | 321-242-8176
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Provider Business Mailing Address
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Address Line | 1310 W EAU GALLIE BLVD STE A
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City | MELBOURNE
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State | FL
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Zip | 32935-5300
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Country | US
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Telephone | 321-254-3630
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Fax | 321-242-8176
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MR. SHAWN T. EGAN
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Credential | DC, PA
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Telephone | 321-254-3630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH4130
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License Number State | FL
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