Healthcare Provider Details

I. General information

NPI: 1184778052
Provider Name (Legal Business Name): KELLY SHOCKLEY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9137 E MINERAL CIR STE 380
CENTENNIAL CO
80112-3424
US

IV. Provider business mailing address

9137 E MINERAL CIR STE 380
CENTENNIAL CO
80112-3424
US

V. Phone/Fax

Practice location:
  • Phone: 303-790-7650
  • Fax: 303-790-7426
Mailing address:
  • Phone: 303-790-7650
  • Fax: 303-790-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5796
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: