Basic Information
| Provider Information | |||||||||
| NPI: | 1518361039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHIREMAN | ||||||||
| FirstName: | JOHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1090 LANG RD APT 5301 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783743118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3612444226 | ||||||||
| FaxNumber: | 8663133397 | ||||||||
| Practice Location | |||||||||
| Address1: | 4117 S STAPLES ST STE 140 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784115506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3612444226 | ||||||||
| FaxNumber: | 8663133397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2014 | ||||||||
| LastUpdateDate: | 10/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NR0400X | 12658 | TX | Y | Chiropractic Providers | Chiropractor | Rehabilitation |
No ID Information.