Individual
DR. JARED MARK SHELTON
Active
Individual
DR. JARED MARK SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, BS, CSCS
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
CHIA-1284
ID
111NS0005X
Sports Physician Chiropractor
Primary
CHIA-1284
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1673568
MEDICARE INDIVIDUAL PTAN
ID
05
—
807952000
—
ID
Enumeration date
01/16/2008
Last updated
09/03/2008
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