Healthcare Provider Details

I. General information

NPI: 1891564746
Provider Name (Legal Business Name): SHELBY ANN HASKINS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NE 91ST ST
KANSAS CITY MO
64155-3329
US

IV. Provider business mailing address

11721 MASTIN ST APT 1708
OVERLAND PARK KS
66210-3643
US

V. Phone/Fax

Practice location:
  • Phone: 816-436-7500
  • Fax:
Mailing address:
  • Phone: 303-828-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2023049821
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: