Provider Demographics
NPI:1689976623
Name:SHAFFER, LANCE MATTHEW (DC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:MATTHEW
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 1:113 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORENCI
Mailing Address - State:MI
Mailing Address - Zip Code:49256-1418
Mailing Address - Country:US
Mailing Address - Phone:517-458-7141
Mailing Address - Fax:517-458-7580
Practice Address - Street 1:113 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MORENCI
Practice Address - State:MI
Practice Address - Zip Code:49256-1418
Practice Address - Country:US
Practice Address - Phone:517-458-7141
Practice Address - Fax:517-458-7580
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor