Provider Demographics
NPI:1356332696
Name:SHAFFER, SCOT ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:ALLEN
Last Name:SHAFFER
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 1:300 S. TWINING ST, BLDG 760
Mailing Address - Street 2:
Mailing Address - City:MAXWELL, AFB
Mailing Address - State:AL
Mailing Address - Zip Code:36112
Mailing Address - Country:US
Mailing Address - Phone:334-953-5143
Mailing Address - Fax:334-953-8296
Practice Address - Street 1:300 S. TWINING ST, BLDG 760
Practice Address - Street 2:
Practice Address - City:MAXWELL, AFB
Practice Address - State:AL
Practice Address - Zip Code:36112
Practice Address - Country:US
Practice Address - Phone:334-953-5143
Practice Address - Fax:334-953-8296
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB36959Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WAU95097Medicare UPIN