Provider Demographics
NPI:1538475850
Name:SHEPHERD CHIROPRACTIC OFFICES, INC.
Entity Type:Organization
Organization Name:SHEPHERD CHIROPRACTIC OFFICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-446-8877
Mailing Address - Street 1:5800 LEGACY DRIVE
Mailing Address - Street 2:SUITE 12C
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024
Mailing Address - Country:US
Mailing Address - Phone:972-446-8877
Mailing Address - Fax:972-446-1142
Practice Address - Street 1:5800 LEGACY DRIVE
Practice Address - Street 2:SUITE 12C
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-446-8877
Practice Address - Fax:972-446-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4514261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC4514OtherLICENSE
TX601779OtherMEDICARE PTAN