Provider Demographics
NPI:1194828202
Name:BLUE, SHELLEY DANA (DC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:DANA
Last Name:BLUE
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 1:342 N CONGRESS AVE
Mailing Address - Street 2:BOYNTON CHIROPRACTIC CENTER, INC
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3465
Mailing Address - Country:US
Mailing Address - Phone:561-733-2508
Mailing Address - Fax:561-733-2658
Practice Address - Street 1:342 N CONGRESS AVE
Practice Address - Street 2:BOYNTON CHIROPRACTIC CENTER, INC
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3465
Practice Address - Country:US
Practice Address - Phone:561-733-2508
Practice Address - Fax:561-733-2658
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPROV55968ZMedicare ID - Type Unspecified
U98540Medicare UPIN
FLGRK5037Medicare ID - Type Unspecified