Provider Demographics
NPI:1275676371
Name:GULLEDGE, SHIRIN MOSHIRI (DC)
Entity Type:Individual
Prefix:
First Name:SHIRIN
Middle Name:MOSHIRI
Last Name:GULLEDGE
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 1:11879 W 112TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2725
Mailing Address - Country:US
Mailing Address - Phone:913-962-7408
Mailing Address - Fax:913-962-7416
Practice Address - Street 1:11879 W 112TH ST
Practice Address - Street 2:STE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2725
Practice Address - Country:US
Practice Address - Phone:913-338-1112
Practice Address - Fax:913-338-2079
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST01052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor