Provider Demographics
NPI:1558327452
Name:FARR, SHANNON HATCHELL
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:HATCHELL
Last Name:FARR
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 1:938 CHEDDAR RD
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-9778
Mailing Address - Country:US
Mailing Address - Phone:864-275-5936
Mailing Address - Fax:
Practice Address - Street 1:918 HIGHWAY 28 BYP
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-1114
Practice Address - Country:US
Practice Address - Phone:864-226-0124
Practice Address - Fax:864-231-9227
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCV08716Medicare UPIN