Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CS2301004440 | MI |
NPI | 1003858739 |
---|---|
Provider Name | Cynthia K Shaft |
First Address | Canton, MI 48187-1310 |
Second Address | Canton, MI 48187-1310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 16/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11430484 | CAQH (01) | MI |
95-OH224870 | BCBS (01) | MI |
CS004440 | (02) | MI |
P31130 | (05) | MI |