Provider Demographics
NPI:1689856551
Name:SHOURDS, JULIE ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ELIZABETH
Last Name:SHOURDS
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 1:665 HIGHWAY 212 W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRANITE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56241-1371
Mailing Address - Country:US
Mailing Address - Phone:320-564-1870
Mailing Address - Fax:320-564-1894
Practice Address - Street 1:665 HIGHWAY 212 W
Practice Address - Street 2:SUITE 1
Practice Address - City:GRANITE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56241-1371
Practice Address - Country:US
Practice Address - Phone:320-564-1870
Practice Address - Fax:320-564-1894
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004005Medicare PIN