Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5796 | CO |
NPI | 1184778052 |
---|---|
Provider Name | Dr. Kelly Shockley |
First Address | Centennial, CO 80112-3424 |
Second Address | Centennial, CO 80112-3424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |