Provider Demographics
NPI:1700557048
Name:CASEY, JASTON SHIELDS (DC)
Entity Type:Individual
Prefix:DR
First Name:JASTON
Middle Name:SHIELDS
Last Name:CASEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JASTON
Other - Middle Name:ANDREW
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:200 N EWING ST
Mailing Address - Street 2:
Mailing Address - City:BOYD
Mailing Address - State:TX
Mailing Address - Zip Code:76023-3118
Mailing Address - Country:US
Mailing Address - Phone:817-734-4732
Mailing Address - Fax:
Practice Address - Street 1:200 N EWING ST
Practice Address - Street 2:
Practice Address - City:BOYD
Practice Address - State:TX
Practice Address - Zip Code:76023-3118
Practice Address - Country:US
Practice Address - Phone:817-734-4732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14870111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology