Healthcare Provider Details

I. General information

NPI: 1932504958
Provider Name (Legal Business Name): SHANE WILLIAM PLUGER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 MICHIGAN ST NE STE C
GRAND RAPIDS MI
49506-1266
US

IV. Provider business mailing address

2815 MICHIGAN ST NE STE C
GRAND RAPIDS MI
49506-1266
US

V. Phone/Fax

Practice location:
  • Phone: 616-272-4039
  • Fax:
Mailing address:
  • Phone: 616-272-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3644880
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: