Provider Demographics
NPI:1043812357
Name:FALCON, SHAVON (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAVON
Middle Name:
Last Name:FALCON
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 1:1305 SURREY LN SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-3632
Mailing Address - Country:US
Mailing Address - Phone:678-549-8692
Mailing Address - Fax:
Practice Address - Street 1:1305 SURREY LN SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-3632
Practice Address - Country:US
Practice Address - Phone:678-549-8692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor