Healthcare Provider Details

I. General information

NPI: 1528623360
Provider Name (Legal Business Name): SHANNON NOEL KEIPER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 PULASKI HWY
BEAR DE
19701-1332
US

IV. Provider business mailing address

6 MALLOW PL
WILMINGTON DE
19810-1638
US

V. Phone/Fax

Practice location:
  • Phone: 302-300-1111
  • Fax:
Mailing address:
  • Phone: 570-578-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0000982
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: