Provider Demographics
NPI:1760120034
Name:NOLLEY, SHAINA NICHOLE (DC, ACN, FMACP)
Entity Type:Individual
Prefix:DR
First Name:SHAINA
Middle Name:NICHOLE
Last Name:NOLLEY
Suffix:
Gender:F
Credentials:DC, ACN, FMACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 BRODIE LN
Mailing Address - Street 2:SUITE 160 PMB909
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748
Mailing Address - Country:US
Mailing Address - Phone:812-252-9280
Mailing Address - Fax:
Practice Address - Street 1:5501 N LAMAR BLVD STE
Practice Address - Street 2:C111
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751
Practice Address - Country:US
Practice Address - Phone:512-200-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36247111N00000X
TX15234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor