Provider Demographics
NPI:1962995084
Name:GOOD, SHANNON (DC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:GOOD
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 1:894 CEDAR CREEK CT SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6648
Mailing Address - Country:US
Mailing Address - Phone:678-787-3985
Mailing Address - Fax:
Practice Address - Street 1:60 WHITLOCK PL SW STE A
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3172
Practice Address - Country:US
Practice Address - Phone:770-726-0195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor