Healthcare Provider Details

I. General information

NPI: 1457889958
Provider Name (Legal Business Name): CHRISTOPHER SHELTON CMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRIS SHELTON

II. Dates (important events)

Enumeration Date: 05/27/2017
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E OLIVE AVE STE 107
BURBANK CA
91502-1849
US

IV. Provider business mailing address

150 E OLIVE AVE STE 107
BURBANK CA
91502-1849
US

V. Phone/Fax

Practice location:
  • Phone: 408-921-5179
  • Fax:
Mailing address:
  • Phone: 408-921-5179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17993
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: