Provider Demographics
NPI:1104565571
Name:SHEPHERD CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:SHEPHERD CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:DC DACBSP
Authorized Official - Phone:563-289-3242
Mailing Address - Street 1:700 EAGLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-9593
Mailing Address - Country:US
Mailing Address - Phone:563-289-3242
Mailing Address - Fax:563-289-4541
Practice Address - Street 1:700 EAGLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:LE CLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-9593
Practice Address - Country:US
Practice Address - Phone:563-289-3242
Practice Address - Fax:563-289-4541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty