| Doctor Name: | ALICE RAYNESFORD SHANAVER |
| NPI Number: | 1730135856 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | 5101008508 |
| Business Practice Address: | 19135 Allen Rd Brownstown Twp, MI - 481836813 |
| Business Phone Number: | 7347479109 |
| Business Fax Number: | 7344791092 |
| Mailing Address: | 19135 Allen Rd, BROWNSTOWN TWP |
| State: | MI |
| Postal Code: | 481836813 |
| Phone Number: | 7347479109 |
| Fax Number: | 7344791092 |
| NPI Enumeration Date: | 05/26/2006 |
| NPI Last Update Date: | 10/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | 5101008508 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |