Provider Demographics
NPI:1912050212
Name:SHANNAHAN, ANDREW GORDON (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:GORDON
Last Name:SHANNAHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 196TH ST SW
Mailing Address - Street 2:STE 1
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-3800
Mailing Address - Country:US
Mailing Address - Phone:425-775-9914
Mailing Address - Fax:425-775-0050
Practice Address - Street 1:2109 196TH ST SW STE 1
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-3800
Practice Address - Country:US
Practice Address - Phone:425-775-9914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAV02301Medicare UPIN
WA8803420Medicare ID - Type Unspecified
WA8803416Medicare PIN