Provider Demographics
NPI:1245930262
Name:HIERLMAIER, SHANE PETER (DC)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:PETER
Last Name:HIERLMAIER
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 1:550 STANTON CHRISTIANA RD STE 302
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2132
Mailing Address - Country:US
Mailing Address - Phone:302-365-6520
Mailing Address - Fax:302-365-6167
Practice Address - Street 1:699 S CARTER RD UNIT 5
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-7754
Practice Address - Country:US
Practice Address - Phone:302-389-8915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0011099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor