Provider Demographics
NPI:1073393005
Name:JEREMIAH M SHAFT DC PLLC
Entity Type:Organization
Organization Name:JEREMIAH M SHAFT DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-941-2211
Mailing Address - Street 1:PO BOX 74126
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-0126
Mailing Address - Country:US
Mailing Address - Phone:734-941-2211
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEREMIAH M SHAFT DC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty