Healthcare Provider Details

I. General information

NPI: 1750339552
Provider Name (Legal Business Name): DAVID J SHIRLEY D. C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 TOLEDO RD STE I
ELKHART IN
46516-5773
US

IV. Provider business mailing address

2707 TOLEDO RD STE I
ELKHART IN
46516-5773
US

V. Phone/Fax

Practice location:
  • Phone: 574-522-9740
  • Fax: 574-522-9740
Mailing address:
  • Phone: 574-522-9740
  • Fax: 574-522-9740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001722A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: