Provider Demographics
NPI:1700836053
Name:SHUSMAN, JEFFREY L (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:SHUSMAN
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 1:6812 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2106
Mailing Address - Country:US
Mailing Address - Phone:215-725-2225
Mailing Address - Fax:215-725-2242
Practice Address - Street 1:6812 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2106
Practice Address - Country:US
Practice Address - Phone:215-725-2225
Practice Address - Fax:215-725-2242
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002968L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1621640OtherHIGHMARK
2303078000OtherIBC
T72503Medicare UPIN
SH64223Medicare ID - Type Unspecified