Healthcare Provider Details

I. General information

NPI: 1063782613
Provider Name (Legal Business Name): SHANNON PEARCE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON BURKE

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 BOSTON RD SUITE E
LEXINGTON KY
40514-1569
US

IV. Provider business mailing address

3650 BOSTON RD STE 188
LEXINGTON KY
40514-1502
US

V. Phone/Fax

Practice location:
  • Phone: 925-487-0253
  • Fax:
Mailing address:
  • Phone: 925-487-0253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5317
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: