Provider Demographics
NPI:1548438013
Name:PARKER, SHANE EVERETT (DC)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:EVERETT
Last Name:PARKER
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 1:1101 TINKER RD
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6107
Mailing Address - Country:US
Mailing Address - Phone:817-428-9595
Mailing Address - Fax:
Practice Address - Street 1:1813 HARWOOD CT
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3190
Practice Address - Country:US
Practice Address - Phone:817-428-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor