Provider Demographics
NPI:1467505446
Name:SHELBURNE, REBECCA JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JEAN
Last Name:SHELBURNE
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 1:4201 W HIGHWAY 146
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9758
Mailing Address - Country:US
Mailing Address - Phone:502-265-0184
Mailing Address - Fax:502-222-8216
Practice Address - Street 1:4201 W HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9758
Practice Address - Country:US
Practice Address - Phone:502-265-0184
Practice Address - Fax:502-222-8216
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY4155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4480965OtherAETNA
KY000000318051OtherBLUE CROSS BLUE SHIELD
KY000000318051OtherBLUE CROSS BLUE SHIELD