Provider Demographics
NPI:1689914897
Name:LISKE, SHELBY (DC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:LISKE
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 1:1194 RED HAWK DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1623
Mailing Address - Country:US
Mailing Address - Phone:469-408-2080
Mailing Address - Fax:
Practice Address - Street 1:4112 LEGACY DR
Practice Address - Street 2:SUITE 326
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-0810
Practice Address - Country:US
Practice Address - Phone:214-872-1232
Practice Address - Fax:214-872-1337
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor