MEDICARE: DR. IAN SHEPSTONE 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	2301010940	MI

General Provider Information

NPI Number	:	1639789522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IAN SHEPSTONE DC

Provider Business Mailing Address
First Line	:	640 CLIFFS DR APT 301B
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48198-7342
Country	:	US
Telephone Number	:	847-471-2248
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 W MICHIGAN AVE
Second Line	:
City	:	GRASS LAKE
State	:	MI
Zip	:	49240-9188
Country	:	US
Telephone Number	:	517-522-8315
Fax Number	:

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

Provider Enumeration Date	:	08/05/2020
Last Update Date	:	08/05/2020

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