Provider Demographics
NPI:1578043139
Name:EDWARDS, SHELLEY (DC, CFMP)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DC, CFMP
Other - Prefix:DR
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:PINARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, CFMP
Mailing Address - Street 1:880 HAMPSHIRE RD STE Y
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2867
Mailing Address - Country:US
Mailing Address - Phone:323-304-6227
Mailing Address - Fax:
Practice Address - Street 1:880 HAMPSHIRE RD STE Y
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2867
Practice Address - Country:US
Practice Address - Phone:323-304-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor