MEDICARE: MR. SHANNON DAVID SMITH D.C.

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	DC005490L	PA

General Provider Information

NPI Number	:	1194819227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHANNON DAVID SMITH D.C.

Provider Business Mailing Address
First Line	:	665 RODI ROAD
Second Line	:	SUITE 100
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-4566
Country	:	US
Telephone Number	:	412-793-8900
Fax Number	:	412-793-8906

Provider Business Practice Location Address
First Line	:	665 RODI ROAD
Second Line	:	SUITE 100
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-4566
Country	:	US
Telephone Number	:	412-793-8900
Fax Number	:	412-793-8906

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/05/2021

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