Provider Demographics
NPI:1730460510
Name:SHUSTERIC, JOSEPH ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:SHUSTERIC
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 1:18571 FORT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7436
Mailing Address - Country:US
Mailing Address - Phone:734-775-4993
Mailing Address - Fax:734-250-7433
Practice Address - Street 1:18571 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7436
Practice Address - Country:US
Practice Address - Phone:734-775-4993
Practice Address - Fax:734-250-7433
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30000001T2G0EAKOtherWRITE PAD OCN CERTIFICATION