Provider Demographics
NPI:1982979100
Name:SHANNA C MILLER, DC PLLC
Entity Type:Organization
Organization Name:SHANNA C MILLER, DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-754-1482
Mailing Address - Street 1:11417 HANSON BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3992
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:55433-3993
Practice Address - Country:US
Practice Address - Phone:763-754-1482
Practice Address - Fax:763-754-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5585261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center