Provider Demographics
NPI:1770087199
Name:SHIFT CHIROPRACTIC, PLC
Entity type:Organization
Organization Name:SHIFT CHIROPRACTIC, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KONAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-499-6858
Mailing Address - Street 1:2400 NORTHERN VISIONS DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7034
Mailing Address - Country:US
Mailing Address - Phone:231-846-8897
Mailing Address - Fax:
Practice Address - Street 1:2400 NORTHERN VISIONS DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7034
Practice Address - Country:US
Practice Address - Phone:231-846-8897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty