Provider Demographics
NPI:1942586680
Name:SHANNON WINTERS DC PA
Entity Type:Organization
Organization Name:SHANNON WINTERS DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-924-9100
Mailing Address - Street 1:2682 SE WILLOUGHBY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4738
Mailing Address - Country:US
Mailing Address - Phone:772-924-9100
Mailing Address - Fax:772-219-1110
Practice Address - Street 1:2682 SE WILLOUGHBY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4738
Practice Address - Country:US
Practice Address - Phone:772-924-9100
Practice Address - Fax:772-219-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty