Provider Demographics
NPI:1972875987
Name:SHANNON T. HERR, DC, PC
Entity type:Organization
Organization Name:SHANNON T. HERR, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HERR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-480-5646
Mailing Address - Street 1:1967 WEHRLE DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8452
Mailing Address - Country:US
Mailing Address - Phone:716-204-8955
Mailing Address - Fax:716-204-8958
Practice Address - Street 1:1967 WEHRLE DR
Practice Address - Street 2:SUITE 12
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8452
Practice Address - Country:US
Practice Address - Phone:716-204-8955
Practice Address - Fax:716-204-8958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10065111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD3482Medicare PIN
NYU86562Medicare UPIN