Provider Demographics
NPI:1235379165
Name:SHELTON CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:SHELTON CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-446-1714
Mailing Address - Street 1:418 DAVIS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4604
Mailing Address - Country:US
Mailing Address - Phone:707-446-1714
Mailing Address - Fax:707-446-6229
Practice Address - Street 1:418 DAVIS ST
Practice Address - Street 2:SUITE B
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4604
Practice Address - Country:US
Practice Address - Phone:707-446-1714
Practice Address - Fax:707-446-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 24219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty