Provider Demographics
NPI:1063415628
Name:DOUGLAS, SHELBY (DC)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16135 PRESTON RD
Mailing Address - Street 2:STE 127, BOX 37
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-3599
Mailing Address - Country:US
Mailing Address - Phone:972-867-7463
Mailing Address - Fax:
Practice Address - Street 1:16135 PRESTON RD
Practice Address - Street 2:STE 127
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-3599
Practice Address - Country:US
Practice Address - Phone:972-867-7463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U93596Medicare UPIN
8A3018Medicare ID - Type Unspecified