MEDICARE: DR. KEVIN MICHAEL SHANAHAN 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	A06065	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093744302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN MICHAEL SHANAHAN D.C.

Provider Business Mailing Address
First Line	:	1004 S BROADWAY ST
Second Line	:	P.O. BOX 96
City	:	TOLEDO
State	:	IA
Zip	:	52342-2302
Country	:	US
Telephone Number	:	641-484-3740
Fax Number	:	641-484-5861

Provider Business Practice Location Address
First Line	:	1004 S BROADWAY ST
Second Line	:
City	:	TOLEDO
State	:	IA
Zip	:	52342-2302
Country	:	US
Telephone Number	:	641-484-3740
Fax Number	:	641-484-5861

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/09/2007

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