Provider Demographics
NPI:1235173790
Name:HERR, SHANNON T (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:T
Last Name:HERR
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 1:1967 WEHRLE DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8452
Mailing Address - Country:US
Mailing Address - Phone:716-204-8955
Mailing Address - Fax:716-204-8958
Practice Address - Street 1:1967 WEHRLE DR
Practice Address - Street 2:SUITE 12
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-8452
Practice Address - Country:US
Practice Address - Phone:716-204-8955
Practice Address - Fax:716-204-8958
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010065-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU86562Medicare UPIN
NYDD3482Medicare PIN