MEDICARE: DR. FRED GLEN SHAY D.C.

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	4263	AZ

General Provider Information

NPI Number	:	1902011893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED GLEN SHAY D.C.

Provider Business Mailing Address
First Line	:	1816 E DUNBAR DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5799
Country	:	US
Telephone Number	:	602-232-2178
Fax Number	:

Provider Business Practice Location Address
First Line	:	5847 S 16TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-3512
Country	:	US
Telephone Number	:	602-268-3451
Fax Number	:	602-268-9179

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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