Provider Demographics
NPI:1215634894
Name:SHELTON, GRANT C (DC)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:C
Last Name:SHELTON
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 1:2213 RIDGEDALE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-5424
Mailing Address - Country:US
Mailing Address - Phone:817-319-0283
Mailing Address - Fax:
Practice Address - Street 1:2213 RIDGEDALE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-5424
Practice Address - Country:US
Practice Address - Phone:817-319-0283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor