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General NPI Number Information
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NPI Number | 1811285265
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Entity Type | Individual
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Provider Name | SHELLEY DAWN GRISSOM D.C.
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Gender | Female
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 1212 BENT OAKS CT STE 200
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City | DENTON
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State | TX
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Zip | 76210-8061
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Country | US
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Telephone | 940-243-0109
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Fax | 940-293-8541
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Provider Business Mailing Address
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Address Line | 1212 BENT OAKS CT STE 200
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City | DENTON
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State | TX
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Zip | 76210-8061
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Country | US
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Telephone | 940-243-0109
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Fax | 940-293-8541
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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 | 10999
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License Number State | TX
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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 | 3895
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License Number State | OK
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