Provider Demographics
NPI:1104002823
Name:BURSHEM, SHAUNA (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:
Last Name:BURSHEM
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 1:404 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GOODHUE
Mailing Address - State:MN
Mailing Address - Zip Code:55027-9200
Mailing Address - Country:US
Mailing Address - Phone:651-923-5717
Mailing Address - Fax:
Practice Address - Street 1:404 N BROADWAY
Practice Address - Street 2:
Practice Address - City:GOODHUE
Practice Address - State:MN
Practice Address - Zip Code:55027-9200
Practice Address - Country:US
Practice Address - Phone:651-923-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004047Medicare PIN