Healthcare Provider Details

I. General information

NPI: 1578566451
Provider Name (Legal Business Name): SHELLEY D WISE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CROSSROADS BLVD
CARMEL CA
93923-8650
US

IV. Provider business mailing address

245 CROSSROADS BLVD
CARMEL CA
93923-8650
US

V. Phone/Fax

Practice location:
  • Phone: 831-373-0985
  • Fax: 831-620-0711
Mailing address:
  • Phone: 831-373-0985
  • Fax: 831-620-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1318520818
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC20443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: