Provider Demographics
NPI:1427387091
Name:NEAL, SHANNON RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:RAY
Last Name:NEAL
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 1:506 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-4331
Mailing Address - Country:US
Mailing Address - Phone:563-324-6325
Mailing Address - Fax:563-323-5180
Practice Address - Street 1:506 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-4331
Practice Address - Country:US
Practice Address - Phone:563-324-6325
Practice Address - Fax:563-323-5180
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA007237OtherIOWA CHIROPRACTOR LICENSE