Provider Demographics
NPI:1750339552
Name:SHIRLEY, DAVID J (D C)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 TOLEDO RD STE I
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-5773
Mailing Address - Country:US
Mailing Address - Phone:574-522-9740
Mailing Address - Fax:574-522-9740
Practice Address - Street 1:2707 TOLEDO RD STE I
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-5773
Practice Address - Country:US
Practice Address - Phone:574-522-9740
Practice Address - Fax:574-522-9740
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001722A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000092311OtherANTHEMBCBS
IN200155790-AMedicaid
IN200155790-AMedicaid
ININ1342Medicare PIN