Provider Demographics
NPI:1689383739
Name:TODD, SHELTON GREY (DC)
Entity type:Individual
Prefix:
First Name:SHELTON
Middle Name:GREY
Last Name:TODD
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 1:18425 DODD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9019
Mailing Address - Country:US
Mailing Address - Phone:952-232-1330
Mailing Address - Fax:
Practice Address - Street 1:18425 DODD BLVD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9019
Practice Address - Country:US
Practice Address - Phone:952-232-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7268111N00000X
MTCHI-CHI-LIC-8000111N00000X
WI6235-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor