Provider Demographics
NPI:1821240086
Name:PAGE, SHELLEY L (DC)
Entity Type:Individual
Prefix:MISS
First Name:SHELLEY
Middle Name:L
Last Name:PAGE
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 1:1749 N WELLS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5877
Mailing Address - Country:US
Mailing Address - Phone:312-440-9646
Mailing Address - Fax:312-440-9644
Practice Address - Street 1:1749 N WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5877
Practice Address - Country:US
Practice Address - Phone:312-440-9646
Practice Address - Fax:312-440-9644
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor