Provider Demographics
NPI:1215282371
Name:SHOEMAKER, JARED JOE (DC)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:JOE
Last Name:SHOEMAKER
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 1:4041 N MAIZE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MAIZE
Mailing Address - State:KS
Mailing Address - Zip Code:67101-8912
Mailing Address - Country:US
Mailing Address - Phone:316-295-4703
Mailing Address - Fax:
Practice Address - Street 1:4041 N MAIZE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:MAIZE
Practice Address - State:KS
Practice Address - Zip Code:67101-8912
Practice Address - Country:US
Practice Address - Phone:316-295-4703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor