MEDICARE: SHIFT CHIROPRACTIC, PLC

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		MI

General Provider Information

NPI Number	:	1770087199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIFT CHIROPRACTIC, PLC

Provider Business Mailing Address
First Line	:	2400 NORTHERN VISIONS DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7034
Country	:	US
Telephone Number	:	231-846-8897
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 NORTHERN VISIONS DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7034
Country	:	US
Telephone Number	:	231-846-8897
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KYLE WILLIAM KONAS
Credential	:	DC
Telephone Number	:	231-499-6858

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	01/12/2023

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Directions to “SHIFT CHIROPRACTIC, PLC ” Practice Location

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