Provider Demographics
NPI:1811285265
Name:GRISSOM, SHELLEY DAWN (DC)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:DAWN
Last Name:GRISSOM
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 1:1212 BENT OAKS CT STE 200
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8061
Mailing Address - Country:US
Mailing Address - Phone:940-243-0109
Mailing Address - Fax:940-293-8541
Practice Address - Street 1:1212 BENT OAKS CT STE 200
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8061
Practice Address - Country:US
Practice Address - Phone:940-243-0109
Practice Address - Fax:940-293-8541
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10999111N00000X
OK3895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor