Provider Demographics
NPI:1336354190
Name:CONNOR, SHANNON (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:CONNOR
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 1:631 IRVINE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5411
Mailing Address - Country:US
Mailing Address - Phone:949-400-9765
Mailing Address - Fax:
Practice Address - Street 1:631 IRVINE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5411
Practice Address - Country:US
Practice Address - Phone:949-400-9765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor