Provider Demographics
NPI:1679703474
Name:CRETORS, SHANDILA GENE (DC)
Entity type:Individual
Prefix:DR
First Name:SHANDILA
Middle Name:GENE
Last Name:CRETORS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 MCCARTY ST
Mailing Address - Street 2:
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-3044
Mailing Address - Country:US
Mailing Address - Phone:361-772-5240
Mailing Address - Fax:
Practice Address - Street 1:505 MCCARTY ST
Practice Address - Street 2:
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995-3044
Practice Address - Country:US
Practice Address - Phone:361-772-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor