Provider Demographics
NPI:1497965057
Name:SUBRAMANIAM, SHANNON RENAE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:RENAE
Last Name:SUBRAMANIAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:RENAE
Other - Last Name:SCHAFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:8002 S 101ST EAST AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4562
Mailing Address - Country:US
Mailing Address - Phone:918-494-8890
Mailing Address - Fax:918-517-3090
Practice Address - Street 1:8002 S 101ST EAST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4562
Practice Address - Country:US
Practice Address - Phone:918-494-8890
Practice Address - Fax:918-517-3090
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor