MEDICARE: DR. KIMBERLY SHANE DRIGGERS 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	6961	TX

General Provider Information

NPI Number	:	1992740138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY SHANE DRIGGERS DC

Provider Business Mailing Address
First Line	:	114 ROCK DOVE LN
Second Line	:
City	:	MCQUEENEY
State	:	TX
Zip	:	78123-3241
Country	:	US
Telephone Number	:	830-560-3073
Fax Number	:	210-490-3911

Provider Business Practice Location Address
First Line	:	1042 CENTRAL PKWY S
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5021
Country	:	US
Telephone Number	:	210-490-3900
Fax Number	:	210-490-3911

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	03/14/2008

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