Provider Demographics
NPI:1508947367
Name:SHETLIN, ROBERT JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAY
Last Name:SHETLIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:JAY
Other - Last Name:SHETLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:9184 SHOSHONE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-6351
Mailing Address - Country:US
Mailing Address - Phone:801-867-9714
Mailing Address - Fax:
Practice Address - Street 1:9184 SHOSHONE LAKE DR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5126
Practice Address - Country:US
Practice Address - Phone:801-867-9714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3740151202111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU78292Medicare UPIN