Provider Demographics
NPI:1174530588
Name:HENRIE, SHANE LEE (DC)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:LEE
Last Name:HENRIE
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 1:2215 POST RD
Mailing Address - Street 2:#1026
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8821
Mailing Address - Country:US
Mailing Address - Phone:512-587-0560
Mailing Address - Fax:
Practice Address - Street 1:2407 S CONGRESS AVE
Practice Address - Street 2:STE D
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5505
Practice Address - Country:US
Practice Address - Phone:512-442-2777
Practice Address - Fax:512-442-2963
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU87655Medicare UPIN
TX8928NOMedicare ID - Type Unspecified