Provider Demographics
NPI:1477760239
Name:ADDLEMAN, SHANNON R (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:R
Last Name:ADDLEMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N GRIFFITH AVE
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67749-1912
Mailing Address - Country:US
Mailing Address - Phone:785-475-2123
Mailing Address - Fax:
Practice Address - Street 1:504 N PENN AVE
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:KS
Practice Address - Zip Code:67749-1619
Practice Address - Country:US
Practice Address - Phone:785-475-2219
Practice Address - Fax:785-475-2210
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062407OtherBCBS
KS062407Medicare PIN