Provider Demographics
NPI:1083087472
Name:WEBER, SHAYLYN (DC)
Entity Type:Individual
Prefix:
First Name:SHAYLYN
Middle Name:
Last Name:WEBER
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 1:6908 PORLAMAR RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-6067
Mailing Address - Country:US
Mailing Address - Phone:608-434-2404
Mailing Address - Fax:
Practice Address - Street 1:2621 COORS BLVD NW STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1729
Practice Address - Country:US
Practice Address - Phone:608-434-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor