MEDICARE: SHELBY JOEL WENDEL DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	08003206A	IN

General Provider Information

NPI Number	:	1265020192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY JOEL WENDEL DC

Provider Business Mailing Address
First Line	:	289 S STATE ROAD 1
Second Line	:
City	:	PORTLAND
State	:	IN
Zip	:	47371-8541
Country	:	US
Telephone Number	:	260-703-0690
Fax Number	:

Provider Business Practice Location Address
First Line	:	4332 FLAGSTAFF CV
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4416
Country	:	US
Telephone Number	:	260-245-0460
Fax Number	:	260-245-0770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/06/2021

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