Provider Demographics
NPI:1467942789
Name:WADE A. SHAFFER D.C. INC.
Entity Type:Organization
Organization Name:WADE A. SHAFFER D.C. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-836-8989
Mailing Address - Street 1:3682 W LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3455
Mailing Address - Country:US
Mailing Address - Phone:814-836-8989
Mailing Address - Fax:
Practice Address - Street 1:3682 W LAKE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505
Practice Address - Country:US
Practice Address - Phone:814-836-8989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007311L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty