Healthcare Provider Details

I. General information

NPI: 1356460836
Provider Name (Legal Business Name): SHELLY MAE BASTIAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLY MAE POSEJPAL D.C.

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W 22ND ST STE 112
LOMBARD IL
60148-6447
US

IV. Provider business mailing address

350 W 22ND ST STE 112
LOMBARD IL
60148-6447
US

V. Phone/Fax

Practice location:
  • Phone: 630-408-6057
  • Fax: 630-326-7882
Mailing address:
  • Phone: 630-408-6057
  • Fax: 630-326-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038010904
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: