Healthcare Provider Details

I. General information

NPI: 1174622088
Provider Name (Legal Business Name): BENJAMIN JASON SHULTZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2686 MONROEVILLE BLVD
MONROEVILLE PA
15146-2302
US

IV. Provider business mailing address

2686 MONROEVILLE BLVD
MONROEVILLE PA
15146-2302
US

V. Phone/Fax

Practice location:
  • Phone: 412-372-3772
  • Fax: 412-372-3688
Mailing address:
  • Phone: 412-372-3772
  • Fax: 412-372-3688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009299
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberAJ009184
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: