Provider Demographics
NPI:1780738294
Name:SHELTON, TODD MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
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 1:1339 NW LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-1427
Mailing Address - Country:US
Mailing Address - Phone:360-740-8554
Mailing Address - Fax:360-740-8207
Practice Address - Street 1:1339 NW LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-1427
Practice Address - Country:US
Practice Address - Phone:360-740-8554
Practice Address - Fax:360-740-8207
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor