Provider Demographics
NPI:1265020192
Name:WENDEL, SHELBY JOEL (DC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:JOEL
Last Name:WENDEL
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 1:289 S STATE ROAD 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-8541
Mailing Address - Country:US
Mailing Address - Phone:260-703-0690
Mailing Address - Fax:
Practice Address - Street 1:4332 FLAGSTAFF CV
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4416
Practice Address - Country:US
Practice Address - Phone:260-245-0460
Practice Address - Fax:260-245-0770
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003206A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor