MEDICARE: JEREMIAH MICHAEL SHAFT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301008888	MI

General Provider Information

NPI Number	:	1053360768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIAH MICHAEL SHAFT D.C.

Provider Business Mailing Address
First Line	:	9340 WAYNE RD
Second Line	:	SUITE 100
City	:	ROMULUS
State	:	MI
Zip	:	48174-1569
Country	:	US
Telephone Number	:	734-941-2211
Fax Number	:	734-941-2466

Provider Business Practice Location Address
First Line	:	9340 WAYNE RD
Second Line	:	SUITE 100
City	:	ROMULUS
State	:	MI
Zip	:	48174-1569
Country	:	US
Telephone Number	:	734-941-2211
Fax Number	:	734-941-2466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/08/2007

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48174-1569

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