MEDICARE: DR. JOSEPH ANTHONY SHUSTERIC 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	2301009801	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30000001T2G0EAK	OTHER	MI	WRITE PAD OCN CERTIFICATION

General Provider Information

NPI Number	:	1730460510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ANTHONY SHUSTERIC D.C.

Provider Business Mailing Address
First Line	:	18571 FORT ST
Second Line	:
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7436
Country	:	US
Telephone Number	:	734-775-4993
Fax Number	:	734-250-7433

Provider Business Practice Location Address
First Line	:	18571 FORT ST
Second Line	:
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7436
Country	:	US
Telephone Number	:	734-775-4993
Fax Number	:	734-250-7433

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

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	01/08/2022

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