Provider Demographics
NPI:1235138454
Name:HOLCOMB, SHANON (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANON
Middle Name:
Last Name:HOLCOMB
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 1:1 VALLEY ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3193
Mailing Address - Country:US
Mailing Address - Phone:717-240-1277
Mailing Address - Fax:717-240-1278
Practice Address - Street 1:1 VALLEY ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3193
Practice Address - Country:US
Practice Address - Phone:717-240-1277
Practice Address - Fax:717-240-1278
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006965-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHO 000229Medicare ID - Type Unspecified
PAU68390Medicare UPIN