Provider Demographics
NPI:1013950864
Name:SHIRVANI, SHIVA (DC)
Entity Type:Individual
Prefix:
First Name:SHIVA
Middle Name:
Last Name:SHIRVANI
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:PO BOX 701359
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-1359
Mailing Address - Country:US
Mailing Address - Phone:972-496-2225
Mailing Address - Fax:972-495-3531
Practice Address - Street 1:3307 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6913
Practice Address - Country:US
Practice Address - Phone:972-496-2225
Practice Address - Fax:972-495-3531
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000U2386Medicaid
TX86Y131Medicare ID - Type Unspecified
TXU59346Medicare UPIN