Provider Demographics
NPI:1255526208
Name:SHELTON, ROBERT JAMES (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:SHELTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 CHICAGO AVENUE SOUTH
Mailing Address - Street 2:#LL08
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407
Mailing Address - Country:US
Mailing Address - Phone:612-879-9500
Mailing Address - Fax:612-879-9504
Practice Address - Street 1:2800 CHICAGO AVENUE SOUTH
Practice Address - Street 2:#LL08
Practice Address - City:MPLS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-879-9500
Practice Address - Fax:612-879-9504
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor