Provider Demographics
NPI:1003858739
Name:SHAFT, CYNTHIA K (DC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:K
Last Name:SHAFT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8584 N CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1310
Mailing Address - Country:US
Mailing Address - Phone:734-455-3933
Mailing Address - Fax:734-455-0316
Practice Address - Street 1:8584 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1310
Practice Address - Country:US
Practice Address - Phone:734-455-3933
Practice Address - Fax:734-455-0316
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICS2301004440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-OH224870OtherBCBS
MIP31130Medicaid
MI11430484OtherCAQH
MICS004440Medicare UPIN
MIP31130Medicaid