1336120799 NPI number — DR. SHANE EVERETT PARSON DC

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	PARSON
Provider First Name	:	SHANE
Provider Middle Name	:	EVERETT
Provider Name Prefix Text	:	DR.
Provider Name Suffix Text	:
Provider Credential Text	:	DC
Provider Gender Code	:	M

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Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
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Provider Other Name Suffix Text	:
Provider Other Credential Text	:
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NPI Number	:	1336120799
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
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Provider First Line Business Mailing Address	:	1514 S ALEXANDER ST
Provider Second Line Business Mailing Address	:	SUITE 201
Provider Business Mailing Address City Name	:	PLANT CITY
Provider Business Mailing Address State Name	:	FL
Provider Business Mailing Address Postal Code	:	33510
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	8137177553
Provider Business Mailing Address Fax Number	:	8137177593

Provider First Line Business Practice Location Address	:	1514 S ALEXANDER ST
Provider Second Line Business Practice Location Address	:	SUITE 201
Provider Business Practice Location Address City Name	:	PLANT CITY
Provider Business Practice Location Address State Name	:	FL
Provider Business Practice Location Address Postal Code	:	33510
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	8137177553
Provider Business Practice Location Address Fax Number	:	8137177593
Provider Enumeration Date	:	11/10/2005

Authorized Official Last Name	:
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• Taxonomy code: 111N00000X , with the licence number:  CH8350 , registered in the state of FL .

• Identifier: CH8350 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "".
• Identifier: U67258 . This identifiers is of the category "".
• Identifier: K5367 , issued by the state of ( FL ) . This identifiers is of the category "".
• Identifier: 70010 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "".