Provider Demographics
NPI:1134385347
Name:SHIRLEY, CARISSA DAWN (DC)
Entity type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:DAWN
Last Name:SHIRLEY
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 1:1650 30TH RD
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:KS
Mailing Address - Zip Code:66544-8659
Mailing Address - Country:US
Mailing Address - Phone:785-382-6357
Mailing Address - Fax:
Practice Address - Street 1:1650 30TH RD
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:KS
Practice Address - Zip Code:66544-8659
Practice Address - Country:US
Practice Address - Phone:785-382-6357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS059949Medicare PIN