Provider Demographics
NPI:1134286958
Name:SHOPE, JEFFREY ROMAN (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROMAN
Last Name:SHOPE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 W SCHROCK RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8956
Mailing Address - Country:US
Mailing Address - Phone:614-794-1777
Mailing Address - Fax:614-794-1379
Practice Address - Street 1:2511 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8956
Practice Address - Country:US
Practice Address - Phone:614-794-1777
Practice Address - Fax:614-794-1379
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2271803Medicaid
OHSH4136651Medicare ID - Type Unspecified