Provider Demographics
NPI:1518144245
Name:SHANNON CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:SHANNON CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-819-8303
Mailing Address - Street 1:14 MANCHESTER SQ STE 120
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7866
Mailing Address - Country:US
Mailing Address - Phone:303-819-8303
Mailing Address - Fax:
Practice Address - Street 1:14 MANCHESTER SQ STE 120
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7866
Practice Address - Country:US
Practice Address - Phone:303-819-8303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty