Provider Demographics
NPI:1891876405
Name:CARPENTER, SHANNON KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KAY
Last Name:CARPENTER
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 1:4505 WOODGATE DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-8203
Mailing Address - Country:US
Mailing Address - Phone:608-754-1234
Mailing Address - Fax:608-754-9494
Practice Address - Street 1:4505 WOODGATE DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-8203
Practice Address - Country:US
Practice Address - Phone:608-754-1234
Practice Address - Fax:608-754-9494
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3216-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU56704Medicare UPIN