MEDICARE: SHAWN TIMOTHY EGAN 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	CH0004130	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952369357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN TIMOTHY EGAN D.C.

Provider Business Mailing Address
First Line	:	1310 W EAU GALLIE BLVD
Second Line	:	SUITE A
City	:	MELBOURNE
State	:	FL
Zip	:	32935-5300
Country	:	US
Telephone Number	:	321-254-3630
Fax Number	:	321-242-8176

Provider Business Practice Location Address
First Line	:	1310 W EAU GALLIE BLVD
Second Line	:	SUITE A
City	:	MELBOURNE
State	:	FL
Zip	:	32935-5300
Country	:	US
Telephone Number	:	321-254-3630
Fax Number	:	321-242-8176

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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Directions to “ SHAWN TIMOTHY EGAN D.C.” Practice Location

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