MEDICARE: KEVIN DYKES SHRUM D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	7886DC	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7886DC	OTHER	TX	TBCE LIC. NO.

General Provider Information

NPI Number	:	1750442984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN DYKES SHRUM D.C.

Provider Business Mailing Address
First Line	:	PO BOX 310701
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78131-0701
Country	:	US
Telephone Number	:	210-748-7200
Fax Number	:	210-293-3458

Provider Business Practice Location Address
First Line	:	6127 SAN PEDRO # 2
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7204
Country	:	US
Telephone Number	:	210-748-7200
Fax Number	:	210-293-3458

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	06/27/2008

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