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General NPI Number Information
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NPI Number | 1285798371
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Entity Type | Organization
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Legal Business Name | CHIRODOCTOR P A
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 16135 PRESTON RD STE. 127
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City | DALLAS
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State | TX
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Zip | 75248-3599
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Country | US
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Telephone | 972-867-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 16135 PRESTON RD STE. 127, BOX 37
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City | DALLAS
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State | TX
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Zip | 75248-3599
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Country | US
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Telephone | 972-867-7463
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHELBY G DOUGLAS
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Credential | DC
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Telephone | 972-867-7463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 9263
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License Number State | TX
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