Provider Demographics
NPI:1831144328
Name:SHAKARIAN, JESSE (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:SHAKARIAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 HIGHWAY 321 N
Mailing Address - Street 2:BLDG 3 SUITE 201
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-6575
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:603 HIGHWAY 321 N
Practice Address - Street 2:BLDG 3 SUITE 201
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-6575
Practice Address - Country:US
Practice Address - Phone:865-988-9815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor