Basic Information
| Provider Information | |||||||||
| NPI: | 1215119698 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHY CHIROPRACTIC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17330 PRESTON RD | ||||||||
| Address2: | SUITE 140A | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752525997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727891234 | ||||||||
| FaxNumber: | 9727891589 | ||||||||
| Practice Location | |||||||||
| Address1: | 17330 PRESTON RD | ||||||||
| Address2: | SUITE 140A | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752525997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727891234 | ||||||||
| FaxNumber: | 9727891589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2007 | ||||||||
| LastUpdateDate: | 03/28/2011 | ||||||||
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| AuthorizedOfficialLastName: | SHY | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | DR GREGORY K SHY, OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9727891234 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 8643 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.