Provider Demographics
NPI:1245686708
Name:ANDERSON, SHELLEY (DC)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:13861 FOLKESTONE CIR APT D
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7829
Mailing Address - Country:US
Mailing Address - Phone:585-576-7890
Mailing Address - Fax:
Practice Address - Street 1:13861 FOLKESTONE CIR APT D
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-7829
Practice Address - Country:US
Practice Address - Phone:585-576-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4973111N00000X
NY012687111N00000X
FLCH11633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor