DR. EDWARD CHARLES SHADIACK III (NPI# 1326278649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326278649 |
| Entity Type | Individual |
| Full Name | DR. EDWARD CHARLES SHADIACK III |
| Credential | D.O. |
| Practice Address |
855 Montgomery St Fort Worth TX 76107-2553 |
| Mailing Address |
Po Box 99335 Fort Worth TX 76199-0335 |
| Practice Telephone | 8177352235 |
| Mailing Telephone | (817) 735-0633 |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2017-07-26 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204D00000X | Neuromusculoskeletal Medicine & OMM | Q5562 | TX | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245339779 | Edward Charles Shadiack Jr. | Family Medicine | 1200 Ne Central Ave # 02, Seaside Park, NJ 08752-1306 | 2006-09-21 |
| Street Address |
855 MONTGOMERY ST |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76107-2553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831194455 | Patricia Lowrimore | Psychiatry & Neurology | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2005-06-20 |
| 1194353417 | Jason L Thompson | Student in an Organized Health Care Education/Training Program | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2020-03-31 |
| 1639701808 | Tyrane Roberts-lagrone | Pharmacist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2020-02-06 |
| 1144860917 | Melissa Edwards Petersen | Clinical Neuropsychologist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2020-01-09 |
| 1629553813 | Lisa Jane Killam-worrall | Pharmacist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2018-10-03 |
| 1598250607 | Sima Taj Mozdbar | Optometrist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2018-06-30 |
| 1588153993 | Kristen Reuter | Social Worker | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2018-05-02 |
| 1114431624 | Emily J. Clark | Counselor | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2017-11-20 |
| 1275073215 | Elizabeth Svyatoslavna Balyakina | Student in an Organized Health Care Education/Training Program | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2017-02-23 |
| 1588103659 | Frederick Olen Barnum Iv | Family Medicine | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2017-02-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629683602 | Renovo Wound and Hyperbarics Pllc | Emergency Medicine | 5668 Edwards Ranch Road, Suite 101, Fort Worth, TX 76107 | 2020-09-15 |
| 1669085437 | Ryan Bourgeois | Nurse Practitioner | 2917 Crocket Street, Fort Worth, TX 76107 | 2020-08-31 |
| 1053920546 | Christa Marie Widjaja | Optometrist | 1700 Montgomery St, Fort Worth, TX 76107 | 2020-07-30 |
| 1093351355 | Raymond Iannone | Pharmacist | 850 Montgomery St, Suite #310, Fort Worth, TX 76107 | 2019-11-21 |
| 1053963744 | Cumulus Injury Resolution, Inc. | Chiropractor | 4936 Byers Avenue, Fort Worth, TX 76107 | 2019-07-12 |
| 1770135576 | Shadia Osakwe | Physician Assistant | 855 Montgomery Street, Pediatric Clinic, Fort Worth, TX 76107 | 2019-07-11 |
| 1568945442 | Sachin P Patel | Physical Therapist | 4825 Wellesley St, Fort Worth, TX 76107 | 2018-09-07 |
| 1023594025 | Ftw Pharmacy Services Inc | Durable Medical Equipment & Medical Supplies | 2912 W 6th St Ste 150, Fort Worth, TX 76107 | 2018-07-13 |
| 1669974325 | Helen Williamson Elliott | Counselor | 1751 River Run #217, Fort Worth, TX 76107 | 2018-03-08 |
| 1487156931 | Pelvic Neuromonitoring Pllc | Electrodiagnostic Medicine | 111 Boland St #211, Ft Worth, TX 76107 | 2018-03-01 |
| Find all providers in zip 76107 | ||||
| Taxonomy Code | 204D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neuromusculoskeletal Medicine & OMM |
| The Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician directs special attention to the neuromusculoskeletal system and its interaction with other body systems. Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine encompasses increased knowledge and understanding of osteopathic principles and practice and heightened technical skills of osteopathic manipulative medicine, and integrates each of these into the management of pediatric, adolescent, adult, and geriatric patients. |
| Notes: Source: American Osteopathic Association, 2017 [7/1/2017: added definition] - Additional Resources: American Osteopathic Board of Neuromusculoskeletal Medicine, 2017, http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922489103 | Dante Paredes | Neuromusculoskeletal Medicine & OMM | 855 Montgomery St Fl 2, Fort Worth, TX 76107-2553 | 2015-06-14 |
| 1710367446 | Marissa May Zajac | Neuromusculoskeletal Medicine & OMM | 5521 Bellaire Dr S Ste 114b, Fort Worth, TX 76109-5855 | 2015-06-08 |
| 1366498438 | David Edward Teitelbaum | Neuromusculoskeletal Medicine & OMM | 4455 Camp Bowie Blvd, Suite 214, Fort Worth, TX 76107-3864 | 2006-05-26 |
| 1275506644 | Scott T Stoll | Neuromusculoskeletal Medicine & OMM | 5717 Edwards Ranch Rd, Fort Worth, TX 76109-4116 | 2006-02-08 |
| 1407829641 | John Licciardone | Neuromusculoskeletal Medicine & OMM | Unthsc Patient Care Center, 999 Montgomery, Fort Worth, TX 76107 | 2006-02-08 |
| 1144209552 | Richard Todd Dombroski | Neuromusculoskeletal Medicine & OMM | 6913 Camp Bowie Blvd Ste 107, Fort Worth, TX 76116-7164 | 2006-01-13 |
| 1548623044 | Nathan Williams | Neuromusculoskeletal Medicine & OMM | 855 Montgomery St Fl 2, Fort Worth, TX 76107-2553 | 2016-04-01 |
| 1013384775 | Lesley Schmitz D.o. and Associates | Neuromusculoskeletal Medicine & OMM | 4545 Bellaire Dr S, Suite 200, Fort Worth, TX 76109-1889 | 2015-08-28 |
| 1700267481 | Matthew Barker | Neuromusculoskeletal Medicine & OMM | 3500 Camp Bowie Blvd, Fort Worth, TX 76107-2644 | 2015-06-18 |
| 1609257971 | Malinda Hansen | Neuromusculoskeletal Medicine & OMM | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2015-06-12 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76107 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.