Provider Demographics
NPI:1750441390
Name:SHOCKLEY, STEVEN RAY (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RAY
Last Name:SHOCKLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16901 WRIGHT PLAZA
Mailing Address - Street 2:183
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130
Mailing Address - Country:US
Mailing Address - Phone:402-334-0840
Mailing Address - Fax:402-334-1474
Practice Address - Street 1:16901 WRIGHT PLAZA
Practice Address - Street 2:183
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130
Practice Address - Country:US
Practice Address - Phone:402-334-0840
Practice Address - Fax:402-334-1474
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NA1072001OtherMEDICARE PTAN
NE36645OtherBLUE CROSS BLUE SHIELD
NE91177190300Medicaid
NA1072001OtherMEDICARE PTAN