Provider Demographics
NPI:1437482031
Name:SHANLEY, SPENCER CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:CHARLES
Last Name:SHANLEY
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 1:8921 WAGON TRL
Mailing Address - Street 2:
Mailing Address - City:CROSSROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-8270
Mailing Address - Country:US
Mailing Address - Phone:214-606-5711
Mailing Address - Fax:
Practice Address - Street 1:5500 N TARRANT PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5391
Practice Address - Country:US
Practice Address - Phone:817-605-9500
Practice Address - Fax:817-605-9503
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor