Provider Demographics
NPI:1417569690
Name:SORTINO, SHELBY DAWN (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:DAWN
Last Name:SORTINO
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:DR
Other - First Name:SHELBY
Other - Middle Name:DAWN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, LAC
Mailing Address - Street 1:1412 2ND AVE SW STE C
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3630
Mailing Address - Country:US
Mailing Address - Phone:701-852-6474
Mailing Address - Fax:701-852-6484
Practice Address - Street 1:1412 2ND AVE SW STE C
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3630
Practice Address - Country:US
Practice Address - Phone:701-852-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor