MEDICARE: DR. GREGORY J SHIRK 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	A05882	IA

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
2	59606	OTHER	IA	BCBS

General Provider Information

NPI Number	:	1629064464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY J SHIRK DC

Provider Business Mailing Address
First Line	:	630 1ST ST NW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-2947
Country	:	US
Telephone Number	:	641-423-4455
Fax Number	:	641-423-0354

Provider Business Practice Location Address
First Line	:	630 1ST ST NW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-2947
Country	:	US
Telephone Number	:	641-423-4455
Fax Number	:	641-423-0354

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	11/19/2014

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