Healthcare Provider Details

I. General information

NPI: 1215119698
Provider Name (Legal Business Name): SHY CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17330 PRESTON RD SUITE 140A
DALLAS TX
75252-5997
US

IV. Provider business mailing address

17330 PRESTON RD SUITE 140A
DALLAS TX
75252-5997
US

V. Phone/Fax

Practice location:
  • Phone: 972-789-1234
  • Fax: 972-789-1589
Mailing address:
  • Phone: 972-789-1234
  • Fax: 972-789-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8643
License Number StateTX

VIII. Authorized Official

Name: DR. GREGORY K SHY
Title or Position: DR GREGORY K SHY, OWNER
Credential: DC
Phone: 972-789-1234