Healthcare Provider Details

I. General information

NPI: 1861490229
Provider Name (Legal Business Name): SHANNON ARLON BURNS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17842 IRVINE BLVD SUITE 102
TUSTIN CA
92780-3203
US

IV. Provider business mailing address

17842 IRVINE BLVD SUITE 102
TUSTIN CA
92780-3203
US

V. Phone/Fax

Practice location:
  • Phone: 949-651-0044
  • Fax: 949-651-0012
Mailing address:
  • Phone: 949-651-0044
  • Fax: 949-651-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number15050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: