Provider Demographics
NPI:1760543805
Name:SHEPHERD, SHELLEY MAE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:MAE
Last Name:SHEPHERD
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 1:824 W MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221
Mailing Address - Country:US
Mailing Address - Phone:517-263-2833
Mailing Address - Fax:517-265-9340
Practice Address - Street 1:824 W MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221
Practice Address - Country:US
Practice Address - Phone:517-263-2833
Practice Address - Fax:517-265-9340
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS005603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
950D850370OtherBCBSM
MI04680OtherPARAMOUNT
MI0D85037OtherMEDICARE GROUP
350045518OtherRAILROAD MEDICARE
MI04680OtherPARAMOUNT
U25908Medicare UPIN