Provider Demographics
NPI:1043259955
Name:DENNIS J SHAY DC PA
Entity Type:Organization
Organization Name:DENNIS J SHAY DC PA
Other - Org Name:MARSCH CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-536-1635
Mailing Address - Street 1:235 ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-6021
Mailing Address - Country:US
Mailing Address - Phone:803-536-1635
Mailing Address - Fax:803-536-1604
Practice Address - Street 1:235 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6021
Practice Address - Country:US
Practice Address - Phone:803-536-1635
Practice Address - Fax:803-536-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH279Medicaid
SC6366Medicare PIN
SC6366Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER