Provider Demographics
NPI:1285441758
Name:VAN GELDEREN, SHELBY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:LEE
Last Name:VAN GELDEREN
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 1:920 W PRAIRIE DR STE J
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3123
Mailing Address - Country:US
Mailing Address - Phone:815-895-3354
Mailing Address - Fax:815-895-3345
Practice Address - Street 1:920 W PRAIRIE DR STE J
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3123
Practice Address - Country:US
Practice Address - Phone:815-895-3354
Practice Address - Fax:815-895-3345
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.014224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor