Provider Demographics
NPI:1538386040
Name:SHIEPIS, KERIC J (DC)
Entity type:Individual
Prefix:DR
First Name:KERIC
Middle Name:J
Last Name:SHIEPIS
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 1:2756 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3392
Mailing Address - Country:US
Mailing Address - Phone:330-453-7733
Mailing Address - Fax:330-453-7821
Practice Address - Street 1:2756 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3392
Practice Address - Country:US
Practice Address - Phone:330-453-7733
Practice Address - Fax:330-453-7821
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0720732Medicaid
OHSH927521Medicare ID - Type UnspecifiedMEDICARE #