Provider Demographics
NPI:1164813614
Name:SHAKLEY CHIROPRACTIC AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:SHAKLEY CHIROPRACTIC AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:SHAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-251-8572
Mailing Address - Street 1:185 HARRY S TRUMAN PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7580
Mailing Address - Country:US
Mailing Address - Phone:410-263-4171
Mailing Address - Fax:410-263-4275
Practice Address - Street 1:185 HARRY S TRUMAN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7580
Practice Address - Country:US
Practice Address - Phone:410-263-4171
Practice Address - Fax:410-263-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03565261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center