Provider Demographics
NPI:1720282643
Name:MIXON, SHAMEKA VIVRE (DC)
Entity Type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:VIVRE
Last Name:MIXON
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 1:1814 ECHO LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3567
Mailing Address - Country:US
Mailing Address - Phone:561-842-3275
Mailing Address - Fax:
Practice Address - Street 1:6501 NW 36TH ST
Practice Address - Street 2:SUITE 387
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6959
Practice Address - Country:US
Practice Address - Phone:305-871-0941
Practice Address - Fax:305-871-0942
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9342111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation