Provider Demographics
NPI:1215713102
Name:RICHARD R. SHAKER DC, PA
Entity type:Organization
Organization Name:RICHARD R. SHAKER DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-876-9552
Mailing Address - Street 1:3314 HENDERSON BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2934
Mailing Address - Country:US
Mailing Address - Phone:813-876-9552
Mailing Address - Fax:813-877-1558
Practice Address - Street 1:3314 HENDERSON BLVD STE 203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2934
Practice Address - Country:US
Practice Address - Phone:813-876-9552
Practice Address - Fax:813-877-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty