Provider Demographics
NPI:1063782613
Name:PEARCE, SHANNON (DC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:PEARCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3650 BOSTON RD
Mailing Address - Street 2:STE 188
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1502
Mailing Address - Country:US
Mailing Address - Phone:925-487-0253
Mailing Address - Fax:
Practice Address - Street 1:3650 BOSTON RD
Practice Address - Street 2:SUITE E
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1569
Practice Address - Country:US
Practice Address - Phone:925-487-0253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor