Provider Demographics
NPI:1720356355
Name:GHIZONI, SHANNA COLLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:COLLEEN
Last Name:GHIZONI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHANNA
Other - Middle Name:COLLEEN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SHANNA SHOUMAN
Mailing Address - Street 1:11417 HANSON BLVD NW, ST 101
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433
Mailing Address - Country:US
Mailing Address - Phone:763-754-1482
Mailing Address - Fax:763-754-6116
Practice Address - Street 1:11417 HANSON BLVD NW
Practice Address - Street 2:ST 101
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3992
Practice Address - Country:US
Practice Address - Phone:763-754-1482
Practice Address - Fax:763-754-6116
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor