Provider Demographics
NPI:1104076835
Name:WHITEHURST, SHANNON COURTNEY (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:COURTNEY
Last Name:WHITEHURST
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:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817-0343
Mailing Address - Country:US
Mailing Address - Phone:252-975-6878
Mailing Address - Fax:252-975-6816
Practice Address - Street 1:103 BERNARD COURT
Practice Address - Street 2:
Practice Address - City:CHOCOWINITY
Practice Address - State:NC
Practice Address - Zip Code:27817
Practice Address - Country:US
Practice Address - Phone:252-975-6878
Practice Address - Fax:252-975-6816
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor