Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5131 | TX |
NPI | 1003097866 |
---|---|
Provider Name | Mr. Bobby Steven Shafer JR. |
First Address | Houston, TX 77089-3602 |
Second Address | Houston, TX 77089-3602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2007 |
Last Update Date | 21/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G03043 | (02) | TX |