Provider Demographics
NPI:1154955318
Name:KLEIN, SHANNON (DC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:KLEIN
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 1:2837 DARLING CT
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-2754
Mailing Address - Country:US
Mailing Address - Phone:608-783-3040
Mailing Address - Fax:844-248-2389
Practice Address - Street 1:2837 DARLING CT
Practice Address - Street 2:
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-2754
Practice Address - Country:US
Practice Address - Phone:608-783-3040
Practice Address - Fax:844-248-2389
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5522-14111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5522-12OtherLICENSE NUMBER