Provider Demographics
NPI:1801309331
Name:WAGNER, SHELBY RENEE (DC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:RENEE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:CRONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7149 WHITESTOWN PKWY
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-7626
Mailing Address - Country:US
Mailing Address - Phone:317-750-8583
Mailing Address - Fax:
Practice Address - Street 1:7149 WHITESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-7626
Practice Address - Country:US
Practice Address - Phone:317-750-8583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003004A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor