Healthcare Provider Details

I. General information

NPI: 1225125842
Provider Name (Legal Business Name): VINCENT LOVELL SHELBY D.C., FIAMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W 2ND ST
MARYVILLE MO
64468-2229
US

IV. Provider business mailing address

206 W 2ND ST
MARYVILLE MO
64468-2229
US

V. Phone/Fax

Practice location:
  • Phone: 660-582-8099
  • Fax: 660-582-5161
Mailing address:
  • Phone: 660-582-8099
  • Fax: 660-582-5161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number005939
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: