Provider Demographics
NPI:1003097866
Name:SHAFER, BOBBY STEVEN JR (DC)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:STEVEN
Last Name:SHAFER
Suffix:JR
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 1:10834 KIRKVALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-3602
Mailing Address - Country:US
Mailing Address - Phone:281-481-8879
Mailing Address - Fax:
Practice Address - Street 1:10834 KIRKVALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-3602
Practice Address - Country:US
Practice Address - Phone:281-481-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG03043Medicare UPIN