Provider Demographics
NPI:1114259769
Name:SHELTON, JOSHUA OLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:OLEN
Last Name:SHELTON
Suffix:
Gender:M
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:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-0031
Mailing Address - Country:US
Mailing Address - Phone:406-291-9444
Mailing Address - Fax:
Practice Address - Street 1:6389 BONNER ST.
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805
Practice Address - Country:US
Practice Address - Phone:406-291-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1401111N00000X
MT1222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor