Provider Demographics
NPI:1083619324
Name:BARGER, SHANNON WILMOT (DC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:WILMOT
Last Name:BARGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4509 NW 23RD AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6570
Mailing Address - Country:US
Mailing Address - Phone:352-377-5158
Mailing Address - Fax:888-871-3404
Practice Address - Street 1:4509 NW 23RD AVE STE 6
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6570
Practice Address - Country:US
Practice Address - Phone:352-377-5158
Practice Address - Fax:888-871-3404
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200178820AMedicaid
172460CMedicare PIN
U65517Medicare UPIN