Provider Demographics
NPI:1841263886
Name:SHAFFER, RODNEY GENE (DC)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:GENE
Last Name:SHAFFER
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 1:62 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-2023
Mailing Address - Country:US
Mailing Address - Phone:570-748-9486
Mailing Address - Fax:570-748-4021
Practice Address - Street 1:62 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2023
Practice Address - Country:US
Practice Address - Phone:570-748-9486
Practice Address - Fax:570-748-4021
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-003169-L111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010301670001Medicaid
PA0010301670001Medicaid
PASH467836Medicare ID - Type Unspecified