Provider Demographics
NPI:1205116993
Name:TAFFE, SHANE (DC)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:
Last Name:TAFFE
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 1:8671 NORTHPARK CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2888
Mailing Address - Country:US
Mailing Address - Phone:515-320-4401
Mailing Address - Fax:
Practice Address - Street 1:8671 NORTHPARK CT
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2888
Practice Address - Country:US
Practice Address - Phone:515-320-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor