Provider Demographics
NPI:1346917994
Name:LORD, SHANNON (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:LORD
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 1:1989 CAPITAL CIR NE STE 1
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4476
Mailing Address - Country:US
Mailing Address - Phone:850-386-7700
Mailing Address - Fax:850-386-7722
Practice Address - Street 1:1989 CAPITAL CIR NE STE 1
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4476
Practice Address - Country:US
Practice Address - Phone:850-386-7700
Practice Address - Fax:850-386-7722
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor