Provider Demographics
NPI:1134137227
Name:SHAMBLIN, GEORGE MONROE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MONROE
Last Name:SHAMBLIN
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 1:617 ELDER WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7133
Mailing Address - Country:US
Mailing Address - Phone:512-341-7330
Mailing Address - Fax:
Practice Address - Street 1:617 ELDER WAY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7133
Practice Address - Country:US
Practice Address - Phone:512-341-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605452OtherBCBS PIN #
TX8A7820OtherBCBS PIN #