Provider Demographics
NPI:1649895566
Name:SHELDON, COLE BRADLEY (DC)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:BRADLEY
Last Name:SHELDON
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 1:30 E LIPOA ST UNIT 4102
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5821
Mailing Address - Country:US
Mailing Address - Phone:913-952-7138
Mailing Address - Fax:
Practice Address - Street 1:30 E LIPOA ST UNIT 4102
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-5821
Practice Address - Country:US
Practice Address - Phone:808-270-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor