Provider Demographics
NPI:1669466025
Name:SHELBY, SKY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:SKY
Middle Name:LEE
Last Name:SHELBY
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 1:8221 COLERAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-3922
Mailing Address - Country:US
Mailing Address - Phone:513-521-4333
Mailing Address - Fax:513-521-4868
Practice Address - Street 1:8221 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-3922
Practice Address - Country:US
Practice Address - Phone:513-521-4333
Practice Address - Fax:513-521-4868
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW0712081Medicaid
OHSH0632222Medicare ID - Type Unspecified
OHT82010Medicare UPIN