Provider Demographics
NPI:1154615623
Name:DR. JOHN SHANLEY CHIROPRACTIC PHYSICIAN LLC
Entity type:Organization
Organization Name:DR. JOHN SHANLEY CHIROPRACTIC PHYSICIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:740-512-9763
Mailing Address - Street 1:115 MARION PL
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3456
Mailing Address - Country:US
Mailing Address - Phone:740-512-6206
Mailing Address - Fax:888-624-8339
Practice Address - Street 1:450 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3770
Practice Address - Country:US
Practice Address - Phone:740-512-9763
Practice Address - Fax:888-624-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty