Provider Demographics
NPI:1184733719
Name:KLINGLER, SHANE AARON (DC)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:AARON
Last Name:KLINGLER
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 1:1770 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512
Mailing Address - Country:US
Mailing Address - Phone:419-782-2250
Mailing Address - Fax:419-784-2347
Practice Address - Street 1:1770 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512
Practice Address - Country:US
Practice Address - Phone:419-782-2250
Practice Address - Fax:419-784-2347
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHACUP-00196171100000X
OHDC-02547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2030555Medicaid
000000119617OtherANTHEM
U74820Medicare UPIN
000000119617OtherANTHEM