Provider Demographics
NPI:1235322884
Name:SHAWN ALAN FYKE
Entity Type:Organization
Organization Name:SHAWN ALAN FYKE
Other - Org Name:CENTEX SPINE & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FYKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-235-0708
Mailing Address - Street 1:205 M B INDUSTRIAL
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6461
Mailing Address - Country:US
Mailing Address - Phone:254-235-0708
Mailing Address - Fax:254-693-7775
Practice Address - Street 1:205 M B INDUSTRIAL
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-6461
Practice Address - Country:US
Practice Address - Phone:254-235-0708
Practice Address - Fax:254-693-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX614014Medicare PIN