Provider Demographics
NPI:1194295436
Name:DERSCHEID, SHANNON BIELSKI (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:BIELSKI
Last Name:DERSCHEID
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:BIELSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7851 SPRING ARBOR RD STE 23
Mailing Address - Street 2:
Mailing Address - City:SPRING ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49283-9503
Mailing Address - Country:US
Mailing Address - Phone:517-795-2775
Mailing Address - Fax:517-796-3119
Practice Address - Street 1:7851 SPRING ARBOR RD STE 23
Practice Address - Street 2:
Practice Address - City:SPRING ARBOR
Practice Address - State:MI
Practice Address - Zip Code:49283-9503
Practice Address - Country:US
Practice Address - Phone:517-796-3119
Practice Address - Fax:517-795-2775
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty