Provider Demographics
NPI:1194819227
Name:SMITH, SHANNON DAVID (DC)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 RODI ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4566
Mailing Address - Country:US
Mailing Address - Phone:412-793-8900
Mailing Address - Fax:412-793-8906
Practice Address - Street 1:665 RODI ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-4566
Practice Address - Country:US
Practice Address - Phone:412-793-8900
Practice Address - Fax:412-793-8906
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005490L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
519086Medicare ID - Type Unspecified
U49093Medicare UPIN