MEDICARE: MR. MICHAEL J. SHANAHAN DC

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	10987	TX

General Provider Information

NPI Number	:	1831342229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL J. SHANAHAN DC

Provider Business Mailing Address
First Line	:	19750 STATE HIGHWAY 46 W STE 102
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6881
Country	:	US
Telephone Number	:	830-438-6689
Fax Number	:	830-438-6691

Provider Business Practice Location Address
First Line	:	19750 STATE HIGHWAY 46 W STE 102
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6881
Country	:	US
Telephone Number	:	830-438-6689
Fax Number	:	830-438-6691

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

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	08/23/2010

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