Healthcare Provider Details

I. General information

NPI: 1194779447
Provider Name (Legal Business Name): SHELLEY RENEE HOOVER-SHEARD D.C., DACBSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12170 TEJON ST STE 400
WESTMINSTER CO
80234-2341
US

IV. Provider business mailing address

12170 TEJON ST STE 400
WESTMINSTER CO
80234-2341
US

V. Phone/Fax

Practice location:
  • Phone: 303-429-0011
  • Fax: 303-429-8001
Mailing address:
  • Phone: 303-429-0011
  • Fax: 303-429-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4870
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: