Basic Information
| Provider Information | |||||||||
| NPI: | 1831387455 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHIER FAMILY CHIROPRACTIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 CORPORATE DR | ||||||||
| Address2: | SUITE H | ||||||||
| City: | BEAVER DAM | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539163119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208210071 | ||||||||
| FaxNumber: | 9208210072 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 CORPORATE DR | ||||||||
| Address2: | SUITE H | ||||||||
| City: | BEAVER DAM | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539163119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208210071 | ||||||||
| FaxNumber: | 9208210072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 01/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHIER | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9208210071 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 4138-012 | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 1518989631 | 01 | WI | NPI PROVIDER NUMBER | OTHER | 39004500 | 05 | WI | MEDICAID |