Provider Demographics
NPI:1013036458
Name:SHAPIRO, CORY ROBERT (DC)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:ROBERT
Last Name:SHAPIRO
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 1:112 SAUNDERSVILLE ROAD
Mailing Address - Street 2:SUITE C-312
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-822-5522
Mailing Address - Fax:615-822-7655
Practice Address - Street 1:109 HAZEL PATH
Practice Address - Street 2:SUITE 5
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3888
Practice Address - Country:US
Practice Address - Phone:615-822-5522
Practice Address - Fax:615-822-7655
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3145758COtherBCBS
661223OtherACN
U79687Medicare UPIN
3971037Medicare ID - Type Unspecified