Provider Demographics
NPI:1477866002
Name:SHAH, MAANSI AJAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MAANSI
Middle Name:AJAY
Last Name:SHAH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 LAKE PARK DR SE APT H
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8971
Mailing Address - Country:US
Mailing Address - Phone:248-890-9212
Mailing Address - Fax:
Practice Address - Street 1:2209 LAKE PARK DR SE APT H
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8971
Practice Address - Country:US
Practice Address - Phone:248-890-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-25
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009685111N00000X
GACHIR008726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor