Provider Demographics
NPI:1518047562
Name:SHELSTAD, JAMES R (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:SHELSTAD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1624
Mailing Address - Country:US
Mailing Address - Phone:262-242-5577
Mailing Address - Fax:
Practice Address - Street 1:122 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1624
Practice Address - Country:US
Practice Address - Phone:262-242-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000135663Medicare ID - Type Unspecified