Healthcare Provider Details

I. General information

NPI: 1992866305
Provider Name (Legal Business Name): DEAN SCOTT SHEPHERD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 W SILVERNAIL RD
PEWAUKEE WI
53072
US

IV. Provider business mailing address

2343 W SILVERNAIL RD
PEWAUKEE WI
53072
US

V. Phone/Fax

Practice location:
  • Phone: 262-548-9000
  • Fax: 262-548-8155
Mailing address:
  • Phone: 262-548-9000
  • Fax: 262-548-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2077
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: