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General NPI Number Information
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NPI Number | 1487997045
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Entity Type | Organization
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Legal Business Name | SHANLEY FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/02/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 5500 N TARRANT PKWY SUITE 108
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City | FORT WORTH
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State | TX
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Zip | 76244-5391
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Country | US
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Telephone | 817-605-9500
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Fax | 817-605-9503
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Provider Business Mailing Address
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Address Line | 5500 N TARRANT PKWY SUITE 108
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City | FORT WORTH
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State | TX
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Zip | 76244-5391
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Country | US
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Telephone | 817-605-9500
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Fax | 817-605-9503
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Authorized Official
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Title or Position | OWNER
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Name | DR. SPENCER C SHANLEY
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Credential | D.C.
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Telephone | 214-714-3759
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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 | 11246
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License Number State | TX
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