MEDICARE: DR SHIDELER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	08000719	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000183222	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1174895742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR SHIDELER PC

Provider Business Mailing Address
First Line	:	753 N MAIN ST
Second Line	:
City	:	BLUFFTON
State	:	IN
Zip	:	46714-1313
Country	:	US
Telephone Number	:	260-824-0318
Fax Number	:

Provider Business Practice Location Address
First Line	:	753 N MAIN ST
Second Line	:
City	:	BLUFFTON
State	:	IN
Zip	:	46714-1313
Country	:	US
Telephone Number	:	260-824-0318
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RANDY SHIDELER
Credential	:	DC
Telephone Number	:	260-824-0318

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	01/30/2012

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Directions to “DR SHIDELER PC ” Practice Location

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