Provider Demographics
NPI:1053595413
Name:SHANE BISSON CHIROPRACTIC PA
Entity type:Organization
Organization Name:SHANE BISSON CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BISSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-345-9888
Mailing Address - Street 1:12100 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1201
Mailing Address - Country:US
Mailing Address - Phone:913-345-9888
Mailing Address - Fax:913-345-0958
Practice Address - Street 1:12100 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1201
Practice Address - Country:US
Practice Address - Phone:913-345-9888
Practice Address - Fax:913-345-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty