Provider Demographics
NPI:1417377748
Name:HAWK, SHANNON M (DC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:HAWK
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 1:9811 MALLARD DR
Mailing Address - Street 2:STE 218
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3143
Mailing Address - Country:US
Mailing Address - Phone:301-953-0256
Mailing Address - Fax:301-604-2097
Practice Address - Street 1:9811 MALLARD DR
Practice Address - Street 2:STE 218
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3143
Practice Address - Country:US
Practice Address - Phone:301-953-0256
Practice Address - Fax:301-604-2097
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor