Provider Demographics
NPI:1154658797
Name:MCBRIDE, SHANNON ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ANN
Last Name:MCBRIDE
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 1:5860 JIMMY CARTER BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-4657
Mailing Address - Country:US
Mailing Address - Phone:770-263-2063
Mailing Address - Fax:770-407-8546
Practice Address - Street 1:5860 JIMMY CARTER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-4657
Practice Address - Country:US
Practice Address - Phone:770-263-2063
Practice Address - Fax:770-407-8546
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor