Provider Demographics
NPI:1346267101
Name:SHANNAN, KEVIN J (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:SHANNAN
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 1:6180 LINWORTH RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2812
Mailing Address - Country:US
Mailing Address - Phone:614-848-5211
Mailing Address - Fax:614-848-0392
Practice Address - Street 1:6180 LINWORTH RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2812
Practice Address - Country:US
Practice Address - Phone:614-848-5211
Practice Address - Fax:614-848-0392
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4253296OtherAETNA
OH1293OtherNGS
OH311549745-014OtherKLAIS & CO.
OH000000203896OtherUNICARE
OH000000203896OtherANTHEM
OH2274319Medicaid
OH311201162-00OtherWORKERS' COMPENSATION
OHT93605Medicare UPIN
OH000000203896OtherANTHEM