Provider Demographics
NPI:1831209402
Name:SHACKELFORD, RICHARD KYLE (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KYLE
Last Name:SHACKELFORD
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 1:20385 VIRGIL H GOODE HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKY MT
Mailing Address - State:VA
Mailing Address - Zip Code:24151
Mailing Address - Country:US
Mailing Address - Phone:540-334-5571
Mailing Address - Fax:540-334-5289
Practice Address - Street 1:20385 VIRGIL H GOODE HWY STE 1
Practice Address - Street 2:
Practice Address - City:ROCKY MT
Practice Address - State:VA
Practice Address - Zip Code:24151
Practice Address - Country:US
Practice Address - Phone:540-334-5571
Practice Address - Fax:540-334-5289
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U60307Medicare UPIN
VAC09752Medicare ID - Type UnspecifiedGROUP
VA00W942A01Medicare ID - Type Unspecified