Provider Demographics
NPI:1316271984
Name:SHANAHAN, REESE ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:REESE
Middle Name:ROBERT
Last Name:SHANAHAN
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 1:16795 COUNTY ROAD 24
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1201
Mailing Address - Country:US
Mailing Address - Phone:651-491-0111
Mailing Address - Fax:
Practice Address - Street 1:16795 COUNTY ROAD 24
Practice Address - Street 2:SUITE 120
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1201
Practice Address - Country:US
Practice Address - Phone:651-491-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor