Provider Demographics
NPI:1093718702
Name:GAERTNER-EWING, SHANNON DEE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:DEE
Last Name:GAERTNER-EWING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3306
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653-3306
Mailing Address - Country:US
Mailing Address - Phone:208-467-5994
Mailing Address - Fax:208-467-5127
Practice Address - Street 1:217 W GEORGIA AVE STE 120
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6812
Practice Address - Country:US
Practice Address - Phone:208-467-5994
Practice Address - Fax:208-467-5127
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA829111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU65584Medicare UPIN