Provider Demographics
NPI:1679592117
Name:SHELTON, TRISTA DIONE (DC)
Entity type:Individual
Prefix:DR
First Name:TRISTA
Middle Name:DIONE
Last Name:SHELTON
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 1:5632 E LA PALMA AVE
Mailing Address - Street 2:A
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2110
Mailing Address - Country:US
Mailing Address - Phone:714-779-3130
Mailing Address - Fax:714-779-3134
Practice Address - Street 1:5632 E LA PALMA AVE
Practice Address - Street 2:A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2110
Practice Address - Country:US
Practice Address - Phone:714-779-3130
Practice Address - Fax:714-779-3134
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor