Provider Demographics
NPI:1184218075
Name:BEHRENS, SHANNAN LYN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNAN
Middle Name:LYN
Last Name:BEHRENS
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 1:73 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2110
Mailing Address - Country:US
Mailing Address - Phone:610-310-6986
Mailing Address - Fax:
Practice Address - Street 1:92 KEMP RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7639
Practice Address - Country:US
Practice Address - Phone:610-705-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor