Provider Demographics
NPI:1174616361
Name:AULTMAN, SHARI ELLEN (DC)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:ELLEN
Last Name:AULTMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 NW 4TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2203
Mailing Address - Country:US
Mailing Address - Phone:218-326-0046
Mailing Address - Fax:218-327-1543
Practice Address - Street 1:1007 NW 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2203
Practice Address - Country:US
Practice Address - Phone:218-326-0046
Practice Address - Fax:218-327-1543
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN032828600Medicaid