Provider Demographics
NPI:1003354960
Name:KIRKWOOD, SHANNON (DC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:KIRKWOOD
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 1:17130 HIGHWAY 46 W STE 110A
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-7116
Mailing Address - Country:US
Mailing Address - Phone:830-885-4477
Mailing Address - Fax:
Practice Address - Street 1:17130 HIGHWAY 46 W STE 110A
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-7116
Practice Address - Country:US
Practice Address - Phone:830-885-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX13813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician