Provider Demographics
NPI:1912042581
Name:BROWN, SHANNON R (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:R
Last Name:BROWN
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:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:IREDELL
Mailing Address - State:TX
Mailing Address - Zip Code:76649-0238
Mailing Address - Country:US
Mailing Address - Phone:254-315-0944
Mailing Address - Fax:
Practice Address - Street 1:8507 BENBROOK BLVD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2561
Practice Address - Country:US
Practice Address - Phone:817-249-6761
Practice Address - Fax:817-249-8780
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor