Provider Demographics
NPI:1154435725
Name:ABERNATHY, SHELLY LYNN (DC)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:ABERNATHY
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:P.O. BOX 348
Mailing Address - Street 2:612 HIGHWAY 150 SOUTH
Mailing Address - City:WEST UNION
Mailing Address - State:IA
Mailing Address - Zip Code:52175-0348
Mailing Address - Country:US
Mailing Address - Phone:563-422-5278
Mailing Address - Fax:563-422-8800
Practice Address - Street 1:612 HIGHWAY 150 SOUTH
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:IA
Practice Address - Zip Code:52175-0348
Practice Address - Country:US
Practice Address - Phone:563-422-5278
Practice Address - Fax:563-422-8800
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0104638Medicaid
IA0104638Medicaid
IAI12778Medicare PIN