Provider Demographics
NPI:1861553547
Name:SHAFFER, SCOTT M (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:SHAFFER
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:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:OH
Mailing Address - Zip Code:43080-0541
Mailing Address - Country:US
Mailing Address - Phone:740-892-4622
Mailing Address - Fax:740-892-4622
Practice Address - Street 1:122 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:OH
Practice Address - Zip Code:43080-0541
Practice Address - Country:US
Practice Address - Phone:740-892-4622
Practice Address - Fax:740-892-4622
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor