Organization
DR SHIDELER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDY SHIDELER DC (PRESIDENT)
(260) 824-0318
Entity
Organization
Contact information
Practice address
753 N MAIN ST, BLUFFTON, IN 46714-1313
(260) 824-0318
Mailing address
753 N MAIN ST, BLUFFTON, IN 46714-1313
(260) 824-0318
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08000719
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000183222
ANTHEM
IN
05
—
100054940A
—
IN
Enumeration date
01/30/2012
Last updated
01/30/2012
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