Provider Demographics
NPI:1568521151
Name:SHUFFLER, KELLY D (DC)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:D
Last Name:SHUFFLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:D
Other - Last Name:NARVARTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2302 N STOCKTON HILL RD
Mailing Address - Street 2:STE. G
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4100
Mailing Address - Country:US
Mailing Address - Phone:928-718-2225
Mailing Address - Fax:928-718-2226
Practice Address - Street 1:2302 N STOCKTON HILL RD STE G
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4100
Practice Address - Country:US
Practice Address - Phone:928-718-2225
Practice Address - Fax:928-718-2226
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U69181Medicare UPIN
Z21735Medicare ID - Type Unspecified