Provider Demographics
NPI:1689770430
Name:KASPRICK, SHELLEY DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:DAWN
Last Name:KASPRICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 N MAIN ST
Mailing Address - Street 2:STE B
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2342
Mailing Address - Country:US
Mailing Address - Phone:435-259-0123
Mailing Address - Fax:435-259-0126
Practice Address - Street 1:4747 KILAUEA AVE #107
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816
Practice Address - Country:US
Practice Address - Phone:808-732-2244
Practice Address - Fax:808-732-4244
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1309111N00000X
UT6348142-1202111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTV11667Medicare UPIN
UT000060138Medicare PIN