Provider Demographics
NPI:1831225150
Name:MATHIS, SHAUNA K (DC)
Entity type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:K
Last Name:MATHIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:221 SAINT ANN DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3219
Mailing Address - Country:US
Mailing Address - Phone:985-624-2250
Mailing Address - Fax:985-624-2572
Practice Address - Street 1:221 SAINT ANN DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3219
Practice Address - Country:US
Practice Address - Phone:985-624-2250
Practice Address - Fax:985-624-2572
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA1371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U42372Medicare UPIN