MEDICARE: DR. ROBERT JAY SHETLIN 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	111NN1001X	Nutrition Chiropractor	3740151202	UT

General Provider Information

NPI Number	:	1508947367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JAY SHETLIN DC

Provider Business Mailing Address
First Line	:	9184 SHOSHONE LAKE DR
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-6351
Country	:	US
Telephone Number	:	801-867-9714
Fax Number	:

Provider Business Practice Location Address
First Line	:	9184 SHOSHONE LAKE DR
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-5126
Country	:	US
Telephone Number	:	801-867-9714
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	02/12/2009

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