Provider Demographics
NPI:1588759955
Name:SHOOK, RAYMOND ULUSTER III (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ULUSTER
Last Name:SHOOK
Suffix:III
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:P.O. BOX 495
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38847
Mailing Address - Country:US
Mailing Address - Phone:662-454-7792
Mailing Address - Fax:
Practice Address - Street 1:27 RED BAY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:MS
Practice Address - Zip Code:38847
Practice Address - Country:US
Practice Address - Phone:662-454-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016146Medicaid
MS00126319Medicaid
MSC03019Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MSU90076Medicare UPIN
MS09016146Medicaid