Provider Demographics
NPI:1154631083
Name:EMMONS, SHANE STUART (DC)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:STUART
Last Name:EMMONS
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 1:825 HENNEPIN AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-1802
Mailing Address - Country:US
Mailing Address - Phone:612-333-9144
Mailing Address - Fax:612-333-9144
Practice Address - Street 1:825 HENNEPIN AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-1802
Practice Address - Country:US
Practice Address - Phone:612-333-9144
Practice Address - Fax:612-333-9144
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor