MEDICARE: DR. JEFFREY L SHUSMAN 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	DC002968L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1621640	OTHER		HIGHMARK
2	2303078000	OTHER		IBC

General Provider Information

NPI Number	:	1700836053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY L SHUSMAN DC

Provider Business Mailing Address
First Line	:	6812 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2106
Country	:	US
Telephone Number	:	215-725-2225
Fax Number	:	215-725-2242

Provider Business Practice Location Address
First Line	:	6812 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2106
Country	:	US
Telephone Number	:	215-725-2225
Fax Number	:	215-725-2242

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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