Provider Demographics
NPI:1184230385
Name:SHELTON CHIROPRACTIC
Entity Type:Organization
Organization Name:SHELTON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-447-1631
Mailing Address - Street 1:428 N STATE ROAD 198 STE B
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-4605
Mailing Address - Country:US
Mailing Address - Phone:801-447-1631
Mailing Address - Fax:801-447-6431
Practice Address - Street 1:428 N STATE ROAD 198 STE B
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653-4605
Practice Address - Country:US
Practice Address - Phone:801-447-1631
Practice Address - Fax:801-447-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty