Provider Demographics
NPI:1386194918
Name:HALLIDAY, SHAWN (DC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:HALLIDAY
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 1:123 3RD AVE E STE 100
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1996
Mailing Address - Country:US
Mailing Address - Phone:320-762-0683
Mailing Address - Fax:
Practice Address - Street 1:123 3RD AVE E STE 100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1996
Practice Address - Country:US
Practice Address - Phone:320-339-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor