Provider Demographics
NPI:1972835775
Name:JOHN P. SHANNON JR., D.C, P.C
Entity Type:Organization
Organization Name:JOHN P. SHANNON JR., D.C, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:907-770-3666
Mailing Address - Street 1:5936 KODY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504
Mailing Address - Country:US
Mailing Address - Phone:907-770-3666
Mailing Address - Fax:907-562-0780
Practice Address - Street 1:4325 LAUREL STREET
Practice Address - Street 2:#280
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-770-3666
Practice Address - Fax:907-562-0780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty