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NPI Code Detail

MEDICARE: DR. SHELLEY D WISE D.C.

MEDICARE: DR. SHELLEY D WISE D.C.
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
1111N00000XChiropractorDC20443CA
2101YA0400XAddiction (Substance Use Disorder) CounselorR1318520818CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17703084230006OTHERCACIGNA
2DC0204430OTHERCABLUE SHIELD
3770308423OTHERCABLUE CROSS

General Provider Information

NPI Number : 1578566451
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHELLEY D WISE D.C.
Provider Business Mailing Address
First Line : 245 CROSSROADS BLVD
Second Line :
City : CARMEL
State : CA
Zip : 93923-8650
Country : US
Telephone Number : 831-373-0985
Fax Number : 831-620-0711
Provider Business Practice Location Address
First Line : 245 CROSSROADS BLVD
Second Line :
City : CARMEL
State : CA
Zip : 93923-8650
Country : US
Telephone Number : 831-373-0985
Fax Number : 831-620-0711
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 09/10/2018

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Directions to “ DR. SHELLEY D WISE D.C.” Practice Location

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