=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255641320
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL C SHAFFER D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2010
-----------------------------------------------------
Last Update Date | 10/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28 PARK ROW
-----------------------------------------------------
City | CHATHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12037-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-567-8809
-----------------------------------------------------
Fax | 518-392-7006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 156 POND HILL ROAD
-----------------------------------------------------
City | CHATHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-567-8809
-----------------------------------------------------
Fax | 518-392-7006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X003671-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111NN0400X
-----------------------------------------------------
Taxonomy Name | Neurology Chiropractor
-----------------------------------------------------
License Number | X003671-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------