Provider Demographics
NPI:1568609089
Name:BREEDING, SHANNON (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:BREEDING
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 1:3507 BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1319
Mailing Address - Country:US
Mailing Address - Phone:804-526-7125
Mailing Address - Fax:804-520-7624
Practice Address - Street 1:3507 BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1319
Practice Address - Country:US
Practice Address - Phone:804-526-7125
Practice Address - Fax:804-520-7624
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor