Provider Demographics
NPI:1427235126
Name:THOMAS, SHANNA M (DC)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:M
Last Name:THOMAS
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 1:1625 ROSWELL RD
Mailing Address - Street 2:APT. 827
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3682
Mailing Address - Country:US
Mailing Address - Phone:770-635-7882
Mailing Address - Fax:
Practice Address - Street 1:1625 ROSWELL RD
Practice Address - Street 2:APT. 827
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3682
Practice Address - Country:US
Practice Address - Phone:770-635-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007980111N00000X
NYX011388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor