Provider Demographics
NPI:1548358096
Name:WALKER, SHANE J (DC)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:J
Last Name:WALKER
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 1:5644 TAVILLA CIR STE 104
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-3404
Mailing Address - Country:US
Mailing Address - Phone:239-325-8226
Mailing Address - Fax:239-325-8226
Practice Address - Street 1:5644 TAVILLA CIR STE 104
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-3404
Practice Address - Country:US
Practice Address - Phone:239-325-8226
Practice Address - Fax:239-325-8226
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22165OtherBCBS FL
FL22165OtherBCBS FL
FL22165ZMedicare PIN