MEDICARE: DR. SHANE WILLIAM PLUGER 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	111NS0005X	Sports Physician Chiropractor	3644880	MI

General Provider Information

NPI Number	:	1932504958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANE WILLIAM PLUGER D.C.

Provider Business Mailing Address
First Line	:	2815 MICHIGAN ST NE STE C
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-1266
Country	:	US
Telephone Number	:	616-272-4039
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 MICHIGAN ST NE STE C
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-1266
Country	:	US
Telephone Number	:	616-272-4039
Fax Number	:

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

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	03/17/2018

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