MEDICARE: DR. SHANNON LEE DEBOER 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	930	SD

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	:	1215007760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON LEE DEBOER D.C.

Provider Business Mailing Address
First Line	:	1501 HIGHWAY 18 BYP STE B
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-9602
Country	:	US
Telephone Number	:	605-745-5119
Fax Number	:	605-745-3016

Provider Business Practice Location Address
First Line	:	1501 HIGHWAY 18 BYP STE B
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-9602
Country	:	US
Telephone Number	:	605-745-5119
Fax Number	:	605-745-3016

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/14/2025

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