Individual
DR. EDWARD CHARLES SHADIACK III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2235
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 735-0633
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
Q5562
TX
Other
Enumeration date
07/21/2009
Last updated
07/21/2022
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