Provider Demographics
NPI:1417976648
Name:SCORE, SHANNON JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:JAY
Last Name:SCORE
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 1:10551 165TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5737
Mailing Address - Country:US
Mailing Address - Phone:952-435-5300
Mailing Address - Fax:
Practice Address - Street 1:10551 165TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5737
Practice Address - Country:US
Practice Address - Phone:952-435-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNC2095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM88G89SCOtherBCBS
FM88G89SCOtherBCBS