Provider Demographics
NPI:1902198591
Name:SHTULMAN, IAN WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:WAYNE
Last Name:SHTULMAN
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 1:8855 HYPOLUXO RD
Mailing Address - Street 2:SUITE C-11
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5250
Mailing Address - Country:US
Mailing Address - Phone:561-275-2525
Mailing Address - Fax:
Practice Address - Street 1:8855 HYPOLUXO RD
Practice Address - Street 2:SUITE C-11
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-5250
Practice Address - Country:US
Practice Address - Phone:561-275-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-14
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor