Healthcare Provider Details

I. General information

NPI: 1083087472
Provider Name (Legal Business Name): SHAYLYN WEBER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 COORS BLVD NW STE D
ALBUQUERQUE NM
87120-1729
US

IV. Provider business mailing address

6908 PORLAMAR RD NW
ALBUQUERQUE NM
87120-6067
US

V. Phone/Fax

Practice location:
  • Phone: 608-434-2404
  • Fax:
Mailing address:
  • Phone: 608-434-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2130
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: