Provider Demographics
NPI:1184778052
Name:SHOCKLEY, KELLY (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:SHOCKLEY
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 1:9137 E MINERAL CIR STE 380
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3424
Mailing Address - Country:US
Mailing Address - Phone:303-790-7650
Mailing Address - Fax:303-790-7426
Practice Address - Street 1:9137 E MINERAL CIR STE 380
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3424
Practice Address - Country:US
Practice Address - Phone:303-790-7650
Practice Address - Fax:303-790-7426
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5796111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician