=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043704521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAFFE HEALTH SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2018
-----------------------------------------------------
Last Update Date | 06/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 S DODGE ST
-----------------------------------------------------
City | ALGONA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50511-2662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-320-4401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 S DODGE ST
-----------------------------------------------------
City | ALGONA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50511-2662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-320-4401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. SHANE MICHAEL TAFFE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 515-320-4401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 007562
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------