Provider Demographics
NPI:1750442984
Name:SHRUM, KEVIN DYKES (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DYKES
Last Name:SHRUM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 310701
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-0701
Mailing Address - Country:US
Mailing Address - Phone:210-748-7200
Mailing Address - Fax:210-293-3458
Practice Address - Street 1:6127 SAN PEDRO # 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7204
Practice Address - Country:US
Practice Address - Phone:210-748-7200
Practice Address - Fax:210-293-3458
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7886DC111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7886DCOtherTBCE LIC. NO.