Healthcare Provider Details

I. General information

NPI: 1447815253
Provider Name (Legal Business Name): SHELTON SPORTS & SPINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ARMSTRONG RD
SHELTON CT
06484-4721
US

IV. Provider business mailing address

110 VALLEYVIEW PL
FAIRFIELD CT
06824-3151
US

V. Phone/Fax

Practice location:
  • Phone: 203-842-8631
  • Fax:
Mailing address:
  • Phone: 203-803-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON QUEIROS
Title or Position: PRESIDENT
Credential: DC
Phone: 203-842-8631