Provider Demographics
NPI:1629296835
Name:LEON, SHANNON (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:LEON
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 BIRCHWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2303
Mailing Address - Country:US
Mailing Address - Phone:631-751-4900
Mailing Address - Fax:516-942-5516
Practice Address - Street 1:222 BIRCHWOOD PARK DRIVE
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753
Practice Address - Country:US
Practice Address - Phone:631-751-4900
Practice Address - Fax:516-942-5516
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010752111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology