Provider Demographics
NPI:1851577175
Name:CROMBACH, SHELLEY ANN (DC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANN
Last Name:CROMBACH
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 1:54 W TWIN OAKS TER
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7140
Mailing Address - Country:US
Mailing Address - Phone:802-658-8878
Mailing Address - Fax:802-658-8879
Practice Address - Street 1:54 W TWIN OAKS TER
Practice Address - Street 2:SUITE 9
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7140
Practice Address - Country:US
Practice Address - Phone:802-658-8878
Practice Address - Fax:802-658-8879
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor