Provider Demographics
NPI:1346021383
Name:SELBY, KIRSTEN NICHOLE (DC)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:NICHOLE
Last Name:SELBY
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 S WILLIAMSON BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-8310
Mailing Address - Country:US
Mailing Address - Phone:386-444-7700
Mailing Address - Fax:386-444-7070
Practice Address - Street 1:5517 S WILLIAMSON BLVD STE 305
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-8310
Practice Address - Country:US
Practice Address - Phone:386-444-7700
Practice Address - Fax:386-444-7070
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor