Provider Demographics
NPI:1225125842
Name:SHELBY, VINCENT LOVELL (DC, FIAMA)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:LOVELL
Last Name:SHELBY
Suffix:
Gender:M
Credentials:DC, FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2229
Mailing Address - Country:US
Mailing Address - Phone:660-582-8099
Mailing Address - Fax:660-582-5161
Practice Address - Street 1:206 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2229
Practice Address - Country:US
Practice Address - Phone:660-582-8099
Practice Address - Fax:660-582-5161
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27741011OtherBC & BS GROUP #
MO1158800OtherCOMMUNITY HEALTH PLAN
MO17447015OtherBLUE CROSS & BLUE SHEILD
MOU18370Medicare UPIN
MO17447015OtherBLUE CROSS & BLUE SHEILD