Provider Demographics
NPI:1750695045
Name:RICHARD A SHELDON DC
Entity type:Organization
Organization Name:RICHARD A SHELDON DC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-863-1920
Mailing Address - Street 1:350D RACETRACK RD NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1699
Mailing Address - Country:US
Mailing Address - Phone:850-863-1920
Mailing Address - Fax:850-864-5961
Practice Address - Street 1:350D RACETRACK RD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1699
Practice Address - Country:US
Practice Address - Phone:850-863-1920
Practice Address - Fax:850-864-5961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH2979FLOtherSTATE LIC FLORIDA
FL88275OtherBCBS ID
FLCH2979FLOtherSTATE LIC FLORIDA