Provider Demographics
NPI:1538367404
Name:COWAN, SHANE T (DC)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:T
Last Name:COWAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 W VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7865
Mailing Address - Country:US
Mailing Address - Phone:214-491-4944
Mailing Address - Fax:214-491-4945
Practice Address - Street 1:1824 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7865
Practice Address - Country:US
Practice Address - Phone:214-491-4944
Practice Address - Fax:214-491-4945
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608400OtherBCBS TEXAS
TX608400OtherBCBS TEXAS