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General NPI Number Information
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NPI Number | 1881585800
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Entity Type | Individual
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Provider Name | JEREMY ADAIR SHELTON RRT
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Gender | Male
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 2401 W MAIN ST
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City | MARION
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State | IL
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Zip | 62959-1188
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Country | US
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Telephone | 618-997-5311
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 HAWKEYE CT
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City | CARTERVILLE
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State | IL
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Zip | 62918-5221
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Country | US
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Telephone | 618-267-2820
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 227900000X
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Taxonomy Name | Registered Respiratory Therapist
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License Number | 194006413
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License Number State | IL
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