Provider Demographics
NPI:1467287649
Name:SHAO, SHELBY (DC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:SHAO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 N HALL ST APT 211
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3685
Mailing Address - Country:US
Mailing Address - Phone:682-438-2397
Mailing Address - Fax:
Practice Address - Street 1:10761 FOUNDERS WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-1574
Practice Address - Country:US
Practice Address - Phone:469-540-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor