Provider Demographics
NPI:1427027994
Name:SARTWELL, SHELLEY A (DC)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:A
Last Name:SARTWELL
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 1:439 BORDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-2446
Mailing Address - Country:US
Mailing Address - Phone:815-895-3805
Mailing Address - Fax:815-899-4133
Practice Address - Street 1:439 BORDEN AVE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2446
Practice Address - Country:US
Practice Address - Phone:815-895-3805
Practice Address - Fax:815-899-4133
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU29283Medicare UPIN
IL970500Medicare ID - Type Unspecified