Provider Demographics
NPI:1407955396
Name:SHUBERT, MELODY J (DC)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:J
Last Name:SHUBERT
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 1:2456 N WOODLAWN BLVD
Mailing Address - Street 2:SUITE 5C
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3968
Mailing Address - Country:US
Mailing Address - Phone:316-636-4444
Mailing Address - Fax:
Practice Address - Street 1:2456 N WOODLAWN BLVD
Practice Address - Street 2:SUITE 5C
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3968
Practice Address - Country:US
Practice Address - Phone:316-636-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC-3869111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS55007OtherBLUE CROSS BLUE SHEILD
KST43969Medicare UPIN
KS055007Medicare ID - Type Unspecified