Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1676 | LA |
N | 111NR0400X | Rehabilitation Chiropractor | 1676 | LA |
NPI | 1285042515 |
---|---|
Provider Name | Shane Henry |
First Address | Metairie, LA 70005-2200 |
Second Address | Metairie, LA 70005-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2014 |
Last Update Date | 29/10/2018 |