Healthcare Provider Details

I. General information

NPI: 1104280650
Provider Name (Legal Business Name): SHANNON KAUFMAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 ROY ST SUITE 100
SEATTLE WA
98109-4219
US

IV. Provider business mailing address

557 ROY ST SUITE 100
SEATTLE WA
98109-4219
US

V. Phone/Fax

Practice location:
  • Phone: 206-285-1068
  • Fax:
Mailing address:
  • Phone: 206-285-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60631494
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: