Provider Demographics
NPI:1255729729
Name:SHANNON B. CHANLER LLC
Entity type:Organization
Organization Name:SHANNON B. CHANLER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHANLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LAC
Authorized Official - Phone:585-645-5468
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-0353
Mailing Address - Country:US
Mailing Address - Phone:585-243-1774
Mailing Address - Fax:
Practice Address - Street 1:5132 GENESEO MOUT MORRIS ROAD
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454
Practice Address - Country:US
Practice Address - Phone:585-243-1774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25003860261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center