Provider Demographics
NPI:1386034213
Name:HILL, SHADANA MIKKEL (DC)
Entity Type:Individual
Prefix:DR
First Name:SHADANA
Middle Name:MIKKEL
Last Name:HILL
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 1:3330 N GALLOWAY AVE
Mailing Address - Street 2:324
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4728
Mailing Address - Country:US
Mailing Address - Phone:214-239-2189
Mailing Address - Fax:
Practice Address - Street 1:3330 N GALLOWAY AVE
Practice Address - Street 2:324
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4728
Practice Address - Country:US
Practice Address - Phone:214-239-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor