Provider Demographics
NPI:1356629703
Name:HALL, SHANNON SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:SCOTT
Last Name:HALL
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 1:1652 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3125
Mailing Address - Country:US
Mailing Address - Phone:423-341-6124
Mailing Address - Fax:
Practice Address - Street 1:1652 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-3125
Practice Address - Country:US
Practice Address - Phone:423-341-6124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor