Healthcare Provider Details

I. General information

NPI: 1932033610
Provider Name (Legal Business Name): SHOCK CHIROPRACTIC GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6308 TRAIL BLVD
NAPLES FL
34108-2836
US

IV. Provider business mailing address

6308 TRAIL BLVD
NAPLES FL
34108-2836
US

V. Phone/Fax

Practice location:
  • Phone: 239-300-0885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: CHARLES SHOCK
Title or Position: OWNER
Credential: DC
Phone: 239-300-0885