Provider Demographics
NPI:1104842673
Name:CARLSON, SHELLEY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:LYNN
Last Name:CARLSON
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 1:1101 SPRINGBROOK LN
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1066
Mailing Address - Country:US
Mailing Address - Phone:563-659-2171
Mailing Address - Fax:
Practice Address - Street 1:602 12TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1124
Practice Address - Country:US
Practice Address - Phone:563-659-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI17044Medicare ID - Type UnspecifiedFOR HILL CHIROPRACTIC
IAU08433Medicare UPIN