Provider Demographics
NPI:1407012495
Name:SHANNON MYERS DC LLC
Entity type:Organization
Organization Name:SHANNON MYERS DC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:W
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-610-0005
Mailing Address - Street 1:111 BROYLES ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2532
Mailing Address - Country:US
Mailing Address - Phone:423-610-0005
Mailing Address - Fax:423-610-0009
Practice Address - Street 1:111 BROYLES ST
Practice Address - Street 2:SUITE 6
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2532
Practice Address - Country:US
Practice Address - Phone:423-610-0005
Practice Address - Fax:423-610-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727029Medicare PIN