Provider Demographics
NPI:1295713832
Name:SHELTON, KENNETH D (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
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 1:1114 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460
Mailing Address - Country:US
Mailing Address - Phone:419-666-1114
Mailing Address - Fax:419-666-6433
Practice Address - Street 1:1114 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1337
Practice Address - Country:US
Practice Address - Phone:419-666-1114
Practice Address - Fax:419-666-6433
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
02136OtherPARAMOUNT HEALTH CARE ID
OH000000133231OtherBLUE CROSS BLUE SHIELD ID
341520061-003OtherMEDICAL MUTUAL ID
4213864OtherAETNA ID
OH1163OtherLICENSE
4213864OtherAETNA ID
OHT96100Medicare UPIN