Provider Demographics
NPI:1760419543
Name:CHILDS, SHANNON MICHAEL I (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:MICHAEL
Last Name:CHILDS
Suffix:I
Gender:M
Credentials:MS, ATC
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Mailing Address - Street 1:1090 IMESON RD
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3424
Mailing Address - Country:US
Mailing Address - Phone:707-826-4106
Mailing Address - Fax:707-826-5446
Practice Address - Street 1:1090 IMESON RD
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3424
Practice Address - Country:US
Practice Address - Phone:707-826-4106
Practice Address - Fax:707-826-5446
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer