Provider Demographics
NPI:1932389186
Name:SHANDY D SELLS DC PC
Entity Type:Organization
Organization Name:SHANDY D SELLS DC PC
Other - Org Name:SELLS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANDY
Authorized Official - Middle Name:DALAN
Authorized Official - Last Name:SELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-946-9715
Mailing Address - Street 1:3616 NW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-946-9715
Mailing Address - Fax:405-946-9756
Practice Address - Street 1:3616 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-946-9715
Practice Address - Fax:405-946-9756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243611503OtherPTAN MEDICARE
OKU86984Medicare UPIN
243611503Medicare PIN
OK300522225Medicare PIN