Provider Demographics
NPI:1962191890
Name:SHACKELFORD, ROBERT L (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
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 1:3319 DURHAM CHAPEL HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2650
Mailing Address - Country:US
Mailing Address - Phone:919-383-9890
Mailing Address - Fax:919-309-0447
Practice Address - Street 1:3319 DURHAM CHAPEL HILL BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2650
Practice Address - Country:US
Practice Address - Phone:919-383-9890
Practice Address - Fax:919-309-0447
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor