Provider Demographics
NPI:1922367143
Name:SHELTON, HEIDI (DC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:SHELTON
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 1:6072 ARIPEKA ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-5005
Mailing Address - Country:US
Mailing Address - Phone:702-353-9642
Mailing Address - Fax:
Practice Address - Street 1:1215 S FORT APACHE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5488
Practice Address - Country:US
Practice Address - Phone:702-362-0336
Practice Address - Fax:702-362-9680
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor