Provider Demographics
NPI:1366655888
Name:COBB, MICHAEL SHANNON (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHANNON
Last Name:COBB
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:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1200
Mailing Address - Country:US
Mailing Address - Phone:334-428-2225
Mailing Address - Fax:334-428-2222
Practice Address - Street 1:305 S THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-4427
Practice Address - Country:US
Practice Address - Phone:334-428-2225
Practice Address - Fax:334-428-2222
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51003674OtherBCBS
ALU75318Medicare UPIN