Provider Demographics
NPI:1588620678
Name:SHAFFER, TERRY L (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
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 1:1038 KAUFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3815
Mailing Address - Country:US
Mailing Address - Phone:937-878-8080
Mailing Address - Fax:937-878-7072
Practice Address - Street 1:1038 KAUFFMAN AVE
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-3815
Practice Address - Country:US
Practice Address - Phone:937-878-8080
Practice Address - Fax:937-878-7072
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0568005Medicaid
OH9339911Medicare PIN
OH4226151Medicare PIN
OHT48278Medicare UPIN