Provider Demographics
NPI:1003308107
Name:SHORTELL, MEGAN FAITH-LEE (DC)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:FAITH-LEE
Last Name:SHORTELL
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 1:7504 VAIL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2924
Mailing Address - Country:US
Mailing Address - Phone:512-992-4569
Mailing Address - Fax:
Practice Address - Street 1:1900 CYPRESS CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3853
Practice Address - Country:US
Practice Address - Phone:512-584-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor