Provider Demographics
NPI:1871690222
Name:SHAVER, RAYMOND TODD (DC DICCP)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:TODD
Last Name:SHAVER
Suffix:
Gender:M
Credentials:DC DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 JUNCTION PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2263
Mailing Address - Country:US
Mailing Address - Phone:910-452-5555
Mailing Address - Fax:910-452-5044
Practice Address - Street 1:4421 JUNCTION PARK DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2263
Practice Address - Country:US
Practice Address - Phone:910-452-5555
Practice Address - Fax:910-452-5044
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1781111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2446941BOtherMEDICARE GROUP PROVIDER PTAN
NC890877BMedicaid
NC0877BOtherBCBS
NC2446941AOtherMEDICARE INDIVIDUAL PROVIDER PTAN
NC890877BMedicaid