Provider Demographics
NPI:1205984952
Name:JORANDBY, SHELLY JO (DC)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:JO
Last Name:JORANDBY
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 1:149 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1651
Mailing Address - Country:US
Mailing Address - Phone:608-524-2213
Mailing Address - Fax:
Practice Address - Street 1:149 N PARK ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1651
Practice Address - Country:US
Practice Address - Phone:608-524-2213
Practice Address - Fax:608-524-2213
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38835300Medicaid
WI38835300Medicaid