=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689914897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELBY LISKE D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2013
-----------------------------------------------------
Last Update Date | 07/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4112 LEGACY DR SUITE 326
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-0810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-872-1232
-----------------------------------------------------
Fax | 214-872-1337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1194 RED HAWK DR
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75033-1623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-408-2080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 11940
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------