Provider Demographics
NPI:1932504958
Name:PLUGER, SHANE WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:WILLIAM
Last Name:PLUGER
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 1:2815 MICHIGAN ST NE STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1266
Mailing Address - Country:US
Mailing Address - Phone:616-272-4039
Mailing Address - Fax:
Practice Address - Street 1:2815 MICHIGAN ST NE STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1266
Practice Address - Country:US
Practice Address - Phone:616-272-4039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3644880111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician