Healthcare Provider Details

I. General information

NPI: 1346021383
Provider Name (Legal Business Name): KIRSTEN NICHOLE SELBY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5517 S WILLIAMSON BLVD STE 305
PORT ORANGE FL
32128-8310
US

IV. Provider business mailing address

5517 S WILLIAMSON BLVD STE 305
PORT ORANGE FL
32128-8310
US

V. Phone/Fax

Practice location:
  • Phone: 386-444-7700
  • Fax: 386-444-7070
Mailing address:
  • Phone: 386-444-7700
  • Fax: 386-444-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH14697
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: