MEDICARE: SHANE COWAN ENTERPRISES, LLC

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	8674	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	608400	OTHER	TX	BCBS TX

General Provider Information

NPI Number	:	1629248075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANE COWAN ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	1824 W VIRGINIA ST
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-7865
Country	:	US
Telephone Number	:	214-491-4944
Fax Number	:	214-491-4945

Provider Business Practice Location Address
First Line	:	1824 W VIRGINIA ST
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-7865
Country	:	US
Telephone Number	:	214-491-4944
Fax Number	:	214-491-4945

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHANE COWAN
Credential	:	D.C.
Telephone Number	:	214-491-4944

Provider Enumeration Date	:	03/01/2008
Last Update Date	:	07/07/2020

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