Provider Demographics
NPI:1659746733
Name:MYERS, SHAUNA (DC)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:
Other - Last Name:DESCHENES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2129 WEBB ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5521
Mailing Address - Country:US
Mailing Address - Phone:717-364-5925
Mailing Address - Fax:
Practice Address - Street 1:1355 FOUR MILE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1932
Practice Address - Country:US
Practice Address - Phone:570-322-1776
Practice Address - Fax:570-322-1774
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030675070001Medicaid
PADC011098OtherDOCTORATE LICENSE