Provider Demographics
NPI:1043253941
Name:SHELBY, DONALD R (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:SHELBY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315-0919
Mailing Address - Country:US
Mailing Address - Phone:423-396-2100
Mailing Address - Fax:423-269-7898
Practice Address - Street 1:5006 UNIVERSITY DR W STE 1200
Practice Address - Street 2:
Practice Address - City:COLLEGEDALE
Practice Address - State:TN
Practice Address - Zip Code:37315-0919
Practice Address - Country:US
Practice Address - Phone:423-396-2100
Practice Address - Fax:423-269-7898
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN004120171OtherBCBS
TN3678631Medicare ID - Type Unspecified