Provider Demographics
NPI:1871126680
Name:SHELTON, CASEY ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:ELIZABETH
Last Name:SHELTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 COLE CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7903
Mailing Address - Country:US
Mailing Address - Phone:225-588-5877
Mailing Address - Fax:
Practice Address - Street 1:1901 POSSUM HOLLOW RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8303
Practice Address - Country:US
Practice Address - Phone:985-646-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor