Provider Demographics
NPI:1497731319
Name:SHAPIRO, IRA A (DC)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:A
Last Name:SHAPIRO
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 1:1314 ENGLISHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1555
Mailing Address - Country:US
Mailing Address - Phone:732-723-0023
Mailing Address - Fax:732-723-1614
Practice Address - Street 1:1314 ENGLISHTOWN RD
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1555
Practice Address - Country:US
Practice Address - Phone:732-723-0023
Practice Address - Fax:732-723-1614
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00270800111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ568654Medicare PIN