Provider Demographics
NPI:1366217325
Name:SHELBY, GARRETT (DC)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:SHELBY
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 1:4936 WUNNENBERG WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4985
Mailing Address - Country:US
Mailing Address - Phone:513-860-5400
Mailing Address - Fax:513-870-5752
Practice Address - Street 1:4936 WUNNENBERG WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4985
Practice Address - Country:US
Practice Address - Phone:513-860-5400
Practice Address - Fax:513-870-5752
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDC-05308OtherLICENSE