Provider Demographics
NPI:1285078188
Name:DAVISON, SHANNA SUE (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:SUE
Last Name:DAVISON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHANNA
Other - Middle Name:SUE
Other - Last Name:BOEHNKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2701 SE CONVENIENCE BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-9432
Mailing Address - Country:US
Mailing Address - Phone:515-443-6636
Mailing Address - Fax:515-635-0009
Practice Address - Street 1:2701 SE CONVENIENCE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-9432
Practice Address - Country:US
Practice Address - Phone:515-443-6636
Practice Address - Fax:515-635-0009
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor