MEDICARE: DR. SHELBY DOUGLAS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	9263	TX

General Provider Information

NPI Number	:	1063415628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELBY DOUGLAS DC

Provider Business Mailing Address
First Line	:	16135 PRESTON RD
Second Line	:	STE 127, BOX 37
City	:	DALLAS
State	:	TX
Zip	:	75248-3599
Country	:	US
Telephone Number	:	972-867-7463
Fax Number	:

Provider Business Practice Location Address
First Line	:	16135 PRESTON RD
Second Line	:	STE 127
City	:	DALLAS
State	:	TX
Zip	:	75248-3599
Country	:	US
Telephone Number	:	972-867-7463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	12/19/2007

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Directions to “ DR. SHELBY DOUGLAS DC” Practice Location

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