Healthcare Provider Details

I. General information

NPI: 1225486533
Provider Name (Legal Business Name): SHANNON KUHN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 E PEARCE BLVD
WENTZVILLE MO
63385-1538
US

IV. Provider business mailing address

610 WINDING CREEK DR
WENTZVILLE MO
63385-3347
US

V. Phone/Fax

Practice location:
  • Phone: 636-327-4752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2016015735
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: