Provider Demographics
NPI:1346243870
Name:TYMCHAK, SHAUN P (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:P
Last Name:TYMCHAK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 W STATE ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2534
Mailing Address - Country:US
Mailing Address - Phone:812-858-1008
Mailing Address - Fax:812-858-1001
Practice Address - Street 1:8211 W STATE ROUTE 66
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2534
Practice Address - Country:US
Practice Address - Phone:812-858-1008
Practice Address - Fax:812-858-1001
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002011A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000314297OtherANTHEM
IN116439OtherSIHO
IN200366440Medicaid
IN5335030001Medicare NSC
IN000000314297OtherANTHEM
IN215730Medicare PIN