Provider Demographics
NPI:1851649776
Name:BURTON, SHAUNA MARIE (L AC)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MARIE
Last Name:BURTON
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2562
Mailing Address - Country:US
Mailing Address - Phone:812-936-0930
Mailing Address - Fax:
Practice Address - Street 1:1009 S MADISON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2562
Practice Address - Country:US
Practice Address - Phone:812-936-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000039A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist