Healthcare Provider Details

I. General information

NPI: 1588696645
Provider Name (Legal Business Name): ROGER ALAN SHELTON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19901 1ST AVE S STE 407
NORMANDY PARK WA
98148-2403
US

IV. Provider business mailing address

19901 1ST AVE S STE 407
NORMANDY PARK WA
98148-2403
US

V. Phone/Fax

Practice location:
  • Phone: 206-870-6177
  • Fax: 206-870-6176
Mailing address:
  • Phone: 206-870-6177
  • Fax: 206-870-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034019
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: