Provider Demographics
NPI:1538923214
Name:GILL, SHANNON KAUR
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:KAUR
Last Name:GILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 165TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6628
Mailing Address - Country:US
Mailing Address - Phone:425-883-2543
Mailing Address - Fax:425-867-1109
Practice Address - Street 1:8250 165TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6628
Practice Address - Country:US
Practice Address - Phone:425-883-2543
Practice Address - Fax:425-867-1109
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61513921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor