Provider Demographics
NPI:1427081314
Name:FYKE, SHAWN (DC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:FYKE
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:PO BOX 7250
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76714-7250
Mailing Address - Country:US
Mailing Address - Phone:254-752-9400
Mailing Address - Fax:254-752-9402
Practice Address - Street 1:6603 SANGER AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4252
Practice Address - Country:US
Practice Address - Phone:254-752-9400
Practice Address - Fax:254-752-9402
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX614014Medicare ID - Type Unspecified
TXU97374Medicare UPIN