Provider Demographics
NPI:1982837878
Name:SHATTUCK, JAMES B
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:B
Last Name:SHATTUCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8760 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TREGO
Mailing Address - State:WI
Mailing Address - Zip Code:54888-9282
Mailing Address - Country:US
Mailing Address - Phone:715-635-6442
Mailing Address - Fax:
Practice Address - Street 1:N8760 RIVER RD
Practice Address - Street 2:
Practice Address - City:TREGO
Practice Address - State:WI
Practice Address - Zip Code:54888-9282
Practice Address - Country:US
Practice Address - Phone:715-635-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI137046174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist