Provider Demographics
NPI:1215951777
Name:ISDALE, SHANE EVAN (DC)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:EVAN
Last Name:ISDALE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:716 INDIAN TRL
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5700
Mailing Address - Country:US
Mailing Address - Phone:254-698-1600
Mailing Address - Fax:254-698-1605
Practice Address - Street 1:716 INDIAN TRL
Practice Address - Street 2:SUITE 120
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5700
Practice Address - Country:US
Practice Address - Phone:254-698-1600
Practice Address - Fax:254-698-1605
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB118034Medicare UPIN
TXTXB116573Medicare UPIN