Provider Demographics
NPI:1942219456
Name:R.A. SHELTON, INC.
Entity Type:Organization
Organization Name:R.A. SHELTON, INC.
Other - Org Name:NORMANDY PARK FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-870-6177
Mailing Address - Street 1:19901 1ST AVE S # 407
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2403
Mailing Address - Country:US
Mailing Address - Phone:206-870-6177
Mailing Address - Fax:206-870-6176
Practice Address - Street 1:19901 1ST AVE S # 407
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2403
Practice Address - Country:US
Practice Address - Phone:206-870-6177
Practice Address - Fax:206-870-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8851660Medicare PIN