Healthcare Provider Details

I. General information

NPI: 1861553547
Provider Name (Legal Business Name): SCOTT M SHAFFER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 SOUTH MAIN ST
UTICA OH
43080-0541
US

IV. Provider business mailing address

PO BOX 541
UTICA OH
43080-0541
US

V. Phone/Fax

Practice location:
  • Phone: 740-892-4622
  • Fax: 740-892-4622
Mailing address:
  • Phone: 740-892-4622
  • Fax: 740-892-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1380
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: