Provider Demographics
NPI:1073055281
Name:MARTIN, SHANNON (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:FINNERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 BARCLAY CIR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2943
Mailing Address - Country:US
Mailing Address - Phone:770-426-2786
Mailing Address - Fax:770-792-6113
Practice Address - Street 1:1415 BARCLAY CIR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2943
Practice Address - Country:US
Practice Address - Phone:770-426-2786
Practice Address - Fax:770-792-6113
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor