Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | 038.013218 | IL |
NPI | 1942790647 |
---|---|
Provider Name | Weston Shelton |
First Address | Clarendon Hills, IL 60514-1203 |
Second Address | Clarendon Hills, IL 60514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 21/05/2018 |