Provider Demographics
NPI:1558367425
Name:SHAFFER, ANTHONY H (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:H
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 1:582 UPPER LEWISBURG SALEM RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-9655
Mailing Address - Country:US
Mailing Address - Phone:937-833-4200
Mailing Address - Fax:937-833-3444
Practice Address - Street 1:582 UPPER LEWISBURG SALEM RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-9655
Practice Address - Country:US
Practice Address - Phone:937-833-4200
Practice Address - Fax:937-833-3444
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2590153OtherAETNA
OH44-20139OtherUNITED HEALTHCARE OF OHIO
OH000000010683OtherANTHEM
OH311043095-00OtherWORKER'S COMPENSATION
OHT46880Medicare UPIN
OH000000010683OtherANTHEM