Provider Demographics
NPI:1578775425
Name:MARTIN, SHAWNA DANIELLE (DC)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:DANIELLE
Last Name:MARTIN
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 1:3502 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-5069
Mailing Address - Country:US
Mailing Address - Phone:502-447-4700
Mailing Address - Fax:502-447-0057
Practice Address - Street 1:3502 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-5069
Practice Address - Country:US
Practice Address - Phone:502-447-4700
Practice Address - Fax:502-447-0057
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005012999111N00000X
KY5063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor