Provider Demographics
NPI:1790756559
Name:BONE, SHANNON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEE
Last Name:BONE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:LEE
Other - Last Name:BONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2012 GREYSTONE PARK
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3575
Mailing Address - Country:US
Mailing Address - Phone:731-664-6998
Mailing Address - Fax:731-664-7161
Practice Address - Street 1:2012 GREYSTONE PARK
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3575
Practice Address - Country:US
Practice Address - Phone:731-664-6998
Practice Address - Fax:731-664-7161
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4083899OtherBCBS NUMBER
TN3501260OtherCIGNA NUMBER
TN3971415Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
TN3723436Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TN4083899OtherBCBS NUMBER