Provider Demographics
NPI:1477563823
Name:SHIBLEY, NOFA JANE (DC)
Entity Type:Individual
Prefix:DR
First Name:NOFA
Middle Name:JANE
Last Name:SHIBLEY
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:PO BOX 4175
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63006
Mailing Address - Country:US
Mailing Address - Phone:314-361-4325
Mailing Address - Fax:
Practice Address - Street 1:625 N EUCLID
Practice Address - Street 2:#225
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108
Practice Address - Country:US
Practice Address - Phone:314-361-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO006581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOBCBS 111678OtherBCBS
MOBCBS 111678OtherBCBS