Healthcare Provider Details

I. General information

NPI: 1639568405
Provider Name (Legal Business Name): SHEA STARK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 CYPRESSWOOD DR STE 207
SPRING TX
77379-7109
US

IV. Provider business mailing address

8500 CYPRESSWOOD DR STE 207
SPRING TX
77379-7109
US

V. Phone/Fax

Practice location:
  • Phone: 281-547-8930
  • Fax: 844-473-1290
Mailing address:
  • Phone: 281-547-8930
  • Fax: 844-473-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHI-CHI-LIC-3454
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: