Provider Demographics
NPI:1417931163
Name:SHAKER, RICHARD ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROBERT
Last Name:SHAKER
Suffix:
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 1:3314 HENDERSON BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2998
Mailing Address - Country:US
Mailing Address - Phone:813-876-9552
Mailing Address - Fax:813-877-1558
Practice Address - Street 1:3314 HENDERSON BLVD
Practice Address - Street 2:STE 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2998
Practice Address - Country:US
Practice Address - Phone:813-876-9552
Practice Address - Fax:813-877-1558
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381409200Medicaid