Provider Demographics
NPI:1093405821
Name:SHELSTAD, CHANTAL MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:MARIE
Last Name:SHELSTAD
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 1:305 E MAIN ST UNIT 24
Mailing Address - Street 2:
Mailing Address - City:DECHERD
Mailing Address - State:TN
Mailing Address - Zip Code:37324-1500
Mailing Address - Country:US
Mailing Address - Phone:254-258-5284
Mailing Address - Fax:
Practice Address - Street 1:25 VETERANS DR
Practice Address - Street 2:
Practice Address - City:DECHERD
Practice Address - State:TN
Practice Address - Zip Code:37324-3887
Practice Address - Country:US
Practice Address - Phone:931-967-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3723111NP0017X, 111NN1001X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition