Healthcare Provider Details

I. General information

NPI: 1982979100
Provider Name (Legal Business Name): SHANNA C MILLER, DC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11417 HANSON BLVD NW ST 101
COON RAPIDS MN
55433-3993
US

IV. Provider business mailing address

11417 HANSON BLVD NW
COON RAPIDS MN
55433-3992
US

V. Phone/Fax

Practice location:
  • Phone: 763-754-1482
  • Fax: 763-754-6116
Mailing address:
  • Phone: 763-754-1482
  • Fax: 763-754-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5585
License Number StateMN

VIII. Authorized Official

Name: DR. SHANNA COLLEEN MILLER
Title or Position: OWNER/ CHIROPRACTOR
Credential: DC
Phone: 763-754-1482