Provider Demographics
NPI:1891884060
Name:SHIFLET, JEFFREY PAUL (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:SHIFLET
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 1:36359 N. GANTZEL RD.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140
Mailing Address - Country:US
Mailing Address - Phone:480-888-7383
Mailing Address - Fax:480-888-7384
Practice Address - Street 1:36359 N. GANTZEL RD.
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140
Practice Address - Country:US
Practice Address - Phone:480-888-7383
Practice Address - Fax:480-888-7384
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0942941OtherBLUE CROSS BLUE SHEILD OF
AZAZ0942940OtherBLUE CROSS BLUE SHEILD OF
AZ5662019OtherFIRST HEALTH/ CCN
V01413Medicare UPIN
AZP00271831Medicare ID - Type UnspecifiedPALMETTO GBA
AZ0942941OtherBLUE CROSS BLUE SHEILD OF
AZZ84108Medicare ID - Type Unspecified