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General NPI Number Information
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NPI Number | 1760120034
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Entity Type | Individual
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Provider Name | SHAINA NICHOLE NOLLEY DC, ACN, FMACP
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Gender | Female
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 5501 N LAMAR BLVD STE C111
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City | AUSTIN
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State | TX
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Zip | 78751
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Country | US
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Telephone | 512-200-2077
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Fax |
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Provider Business Mailing Address
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Address Line | 9901 BRODIE LN SUITE 160 PMB909
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City | AUSTIN
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State | TX
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Zip | 78748
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Country | US
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Telephone | 812-252-9280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 36247
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 15234
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License Number State | TX
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