DR. JOHN RICHARD SHACK (NPI# 1942478706) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942478706 |
| Entity Type | Individual |
| Full Name | DR. JOHN RICHARD SHACK |
| Credential | PH.D. |
| Practice Address |
713 Wilderness Dr. Douglas MI 49406-0140 |
| Mailing Address |
713 Wilderness Drive P. O. Box 140 Douglas MI 49406-0140 |
| Practice Telephone | 2698578644 |
| Practice Fax Number | 2698578644 |
| Mailing Telephone | 2698578644 |
| Mailing Fax Number | 2698578644 |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2008-02-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
6301011374 | MI | Behavioral Health & Social Service Providers |
| Street Address |
713 WILDERNESS DR. |
| City | DOUGLAS |
| State | MI |
| Zip Code | 49406-0140 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679657407 | Martin George Raebel II | Dentist | 430 Wiley Road, Douglas, MI 49406 | 2006-10-25 |
| 1629185459 | Nicole Boxer, Md, PC | Family Medicine | 2993 Blue Star Hwy, Suite 102, Douglas, MI 49406 | 2006-08-25 |
| 1588650543 | Nanmax Health Management Inc | Skilled Nursing Facility | 243 Wiley Road, Douglas, MI 49406-0217 | 2005-09-26 |
| 1043270390 | Richard C. Annis IIi | Optometrist | 114 Blue Star Highway, Douglas, MI 49406-0280 | 2006-03-23 |
| 1053583476 | Richard C Annis Od PC | Optometrist | 114 Blue Star Highway, Douglas, MI 49406-0280 | 2008-03-26 |
| 1770708372 | A. Joseph Hoski | Orthopaedic Surgery | 177 St. Peter's Drive, Douglas, MI 49406-1027 | 2007-04-17 |
| 1750932125 | Ruth Ann Vanden Bosch | Counselor | 346 Mariners Cove, 30 D, 30 D, Douglas, MI 49406-4940 | 2019-09-26 |
| 1205802303 | Tracey Jean Dellavecchia | Dentist | 430 130th Ave, Douglas, MI 49406-5100 | 2006-02-27 |
| 1982836714 | Dellavecchia Dental Services, P.C. | Clinic/Center | 430 130th Ave, Douglas, MI 49406-5100 | 2009-08-12 |
| 1760652853 | Douglas Investments & Associates, LLC | Skilled Nursing Facility | 243 Wiley Rd, Douglas, MI 49406-5108 | 2008-03-05 |
| Find all providers in zip 49406 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245831296 | Reema S. Beri, Phd, LLC | Psychologist | 49410 Waterstone Estates Cir, Northville, MI 48168-4900 | 2020-11-05 |
| 1952901225 | Northerner Psychological Services, Pllc | Psychologist | 1869 Melbourne St, Birmingham, MI 48009-1160 | 2020-10-27 |
| 1083213631 | Robert J. Sheppard Phd Pllc | Psychologist | 8339 Brookwood Dr, Portage, MI 49024-5207 | 2020-10-23 |
| 1952900037 | Jamila Simone Steward | Psychologist | 31275 Northwestern Hwy Ste 216, Farmington Hills, MI 48334-2570 | 2020-10-20 |
| 1992303465 | Madison Bryant | Psychologist | 1231 S Cass Lake Rd, Waterford, MI 48328-4739 | 2020-10-15 |
| 1730787664 | Athal Yako | Psychologist | 18230 Teresa Dr, Macomb, MI 48044-1681 | 2020-10-13 |
| 1538767678 | Up Telehealth, LLC | Psychologist | 228 W Washington St Ste 7, Marquette, MI 49855-4330 | 2020-10-12 |
| 1881292076 | Meaningful Change: Clinical & Consultation Psychology, Pllc | Psychologist | 1861 Woodland Dr, Mount Pleasant, MI 48858-1298 | 2020-10-11 |
| 1902404122 | Dorrean Riley | Psychologist | 19189 Lexington, Redford, MI 48240-2618 | 2020-10-09 |
| 1174130850 | Timber Creek Counseling West LLC | Psychologist | 2976 Ivanrest Ave Sw Ste 215, Grandville, MI 49418-1440 | 2020-09-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.