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General NPI Number Information
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NPI Number | 1639789522
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Entity Type | Individual
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Provider Name | IAN SHEPSTONE DC
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Gender | Male
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Dates
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Enumeration Date | 08/05/2020
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 139 W MICHIGAN AVE
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City | GRASS LAKE
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State | MI
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Zip | 49240-9188
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Country | US
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Telephone | 517-522-8315
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Fax |
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Provider Business Mailing Address
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Address Line | 640 CLIFFS DR APT 301B
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City | YPSILANTI
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State | MI
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Zip | 48198-7342
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Country | US
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Telephone | 847-471-2248
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301010940
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License Number State | MI
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