Provider Demographics
NPI:1225076045
Name:SHELDON, RICHARD A (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:SHELDON
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 1:350D RACETRACK RD NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1699
Mailing Address - Country:US
Mailing Address - Phone:850-863-1920
Mailing Address - Fax:850-864-5961
Practice Address - Street 1:350D RACETRACK RD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1699
Practice Address - Country:US
Practice Address - Phone:850-863-1920
Practice Address - Fax:850-864-5961
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10728197OtherCAQH
FL88275OtherBC/BS ID #
FLCH2979OtherFL CHIRO LIC NUMBER
FL88275OtherBC/BS ID #
FL88275OtherBC/BS ID #