MEDICARE: SHANNON WILMOT BARGER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH12907	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083619324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON WILMOT BARGER DC

Provider Business Mailing Address
First Line	:	4509 NW 23RD AVE STE 6
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6570
Country	:	US
Telephone Number	:	352-377-5158
Fax Number	:	888-871-3404

Provider Business Practice Location Address
First Line	:	4509 NW 23RD AVE STE 6
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6570
Country	:	US
Telephone Number	:	352-377-5158
Fax Number	:	888-871-3404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/13/2020

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Directions to “ SHANNON WILMOT BARGER DC” Practice Location

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