Provider Demographics
NPI:1932378676
Name:MCILNAY, SHANNON MIDORI (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MIDORI
Last Name:MCILNAY
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 1:151 N SUNRISE AVE STE 907
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2929
Mailing Address - Country:US
Mailing Address - Phone:916-786-5828
Mailing Address - Fax:916-786-5055
Practice Address - Street 1:151 N SUNRISE AVE STE 907
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2929
Practice Address - Country:US
Practice Address - Phone:916-786-5828
Practice Address - Fax:916-786-5055
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor