Provider Demographics
NPI:1023330149
Name:SHANE, DARCY RAE (DC)
Entity type:Individual
Prefix:DR
First Name:DARCY
Middle Name:RAE
Last Name:SHANE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W AMITY ST
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-6320
Mailing Address - Country:US
Mailing Address - Phone:913-837-3310
Mailing Address - Fax:913-440-0511
Practice Address - Street 1:825 W AMITY ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-6320
Practice Address - Country:US
Practice Address - Phone:913-837-3310
Practice Address - Fax:913-440-0511
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor