Provider Demographics
NPI:1619507837
Name:SHELTON, NICHOLAS TODD (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:TODD
Last Name:SHELTON
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 1:826 N 100 E STE 5B
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1241
Mailing Address - Country:US
Mailing Address - Phone:801-447-1631
Mailing Address - Fax:801-447-6431
Practice Address - Street 1:4652 W VISTA DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9573
Practice Address - Country:US
Practice Address - Phone:801-404-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11567226-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty