Provider Demographics
NPI:1144516477
Name:SHANE, ERIC (DC, EMT)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:SHANE
Suffix:
Gender:M
Credentials:DC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16200 AMBER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-4051
Mailing Address - Country:US
Mailing Address - Phone:505-459-4611
Mailing Address - Fax:
Practice Address - Street 1:16200 AMBER VALLEY DR
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-4051
Practice Address - Country:US
Practice Address - Phone:505-459-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor