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General NPI Number Information
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NPI Number | 1215673504
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Entity Type | Individual
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Provider Name | DOMINIC SHUTTLEWORTH DO
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Gender | Male
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 801 E SIOUX AVE
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City | PIERRE
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State | SD
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Zip | 57501-3323
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Country | US
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Telephone | 605-224-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 204 E MEADE ST
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City | RAPID CITY
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State | SD
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Zip | 57701-5658
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Country | US
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Telephone | 907-978-5614
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17650
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License Number State | SD
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