Provider Demographics
NPI:1447587456
Name:JAY, SHAUN MICHAEL (DC, MS)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:MICHAEL
Last Name:JAY
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MARTICVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-9508
Mailing Address - Country:US
Mailing Address - Phone:717-283-1155
Mailing Address - Fax:
Practice Address - Street 1:8 MARTICVILLE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-9508
Practice Address - Country:US
Practice Address - Phone:717-283-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010167111N00000X
PAAJ009974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor