Provider Demographics
NPI:1083804355
Name:SHUTKO, NICOLE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:SHUTKO
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 1:3910 KIRBY DR
Mailing Address - Street 2:STE 212
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4120
Mailing Address - Country:US
Mailing Address - Phone:713-522-2886
Mailing Address - Fax:713-522-2738
Practice Address - Street 1:3910 KIRBY DR
Practice Address - Street 2:STE 212
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4120
Practice Address - Country:US
Practice Address - Phone:713-522-2886
Practice Address - Fax:713-522-2738
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8742111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AK973OtherBCBS