=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194432302
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHEAFFER FAMILY CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2022
-----------------------------------------------------
Last Update Date | 10/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 804 LOUCKS RD
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17404-1928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-843-9355
-----------------------------------------------------
Fax | 717-854-9355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 804 LOUCKS RD
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17404-1928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-843-9355
-----------------------------------------------------
Fax | 717-854-9355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | JAMES SHEAFFER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 717-843-9355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------