1306371984 NPI number — PAIN STOP MD

Table of content: DR. JASON ALAN SHUMARD D.C. (NPI 1750590659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306371984 NPI number — PAIN STOP MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN STOP MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306371984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25900 GREENFIELD RD
Provider Second Line Business Mailing Address:
STE 140
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48237-1292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25900 GREENFIELD RD
Provider Second Line Business Practice Location Address:
STE 140
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48237-1292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-474-4038
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JAYAKAR
Authorized Official First Name:
SHAUN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
734-474-4038

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , with the licence number:  4301086680 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)