Provider Demographics
NPI:1427263128
Name:BURNS, SHELLY MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:MARIE
Last Name:BURNS
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 1:1720 S MICHIGAN AVE
Mailing Address - Street 2:1513
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1465
Mailing Address - Country:US
Mailing Address - Phone:818-419-5995
Mailing Address - Fax:
Practice Address - Street 1:733 S WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4507
Practice Address - Country:US
Practice Address - Phone:818-419-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29258111NS0005X
IL038012078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician