Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | X003671-1 | NY |
Y | 111NN0400X | Neurology | X003671-1 | NY |
NPI | 1255641320 |
---|---|
Provider Name | Dr. Michael C Shaffer |
First Address | Chatham, NY 12037 |
Second Address | Chatham, NY 12037-1210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2010 |
Last Update Date | 07/10/2010 |