MEDICARE: SHARI ELLEN AULTMAN DC

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	2605	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174616361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARI ELLEN AULTMAN DC

Provider Business Mailing Address
First Line	:	1007 NW 4TH ST STE B
Second Line	:
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744-2203
Country	:	US
Telephone Number	:	218-326-0046
Fax Number	:	218-327-1543

Provider Business Practice Location Address
First Line	:	1007 NW 4TH ST STE B
Second Line	:
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744-2203
Country	:	US
Telephone Number	:	218-326-0046
Fax Number	:	218-327-1543

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	02/26/2025

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