Provider Demographics
NPI:1093805475
Name:ELLIOTT, SHAWN KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:KEVIN
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 1099
Mailing Address - Street 2:
Mailing Address - City:LINN
Mailing Address - State:MO
Mailing Address - Zip Code:65051
Mailing Address - Country:US
Mailing Address - Phone:573-897-0100
Mailing Address - Fax:573-897-3966
Practice Address - Street 1:1016 E MAIN
Practice Address - Street 2:
Practice Address - City:LINN
Practice Address - State:MO
Practice Address - Zip Code:65051
Practice Address - Country:US
Practice Address - Phone:573-897-0100
Practice Address - Fax:573-897-3966
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5326OtherANTHEM BLUE CROSS & BLUE
MO5326OtherBLUECHOICE
MO5326OtherBLUE CROSS BLUE SHIELD
MO130514OtherGHP
MO611449400OtherUS DEPT OF LABOR - DFEC
MO239265OtherHEALTHLINK
MO44-20000OtherUNITED HEALTHCARE
MO700081OtherHEALTH PARTNERS
MOU21297Medicare UPIN
MO44-20000OtherUNITED HEALTHCARE