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General NPI Number Information
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NPI Number | 1073274098
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Entity Type | Individual
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Provider Name | SHANNON TAYLOR SPRAGUE
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Gender | Female
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Dates
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Enumeration Date | 01/02/2022
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Last Update Date | 01/02/2022
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Provider Practice Location Address
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Address Line | 3313 CHILI AVE STE E
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City | ROCHESTER
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State | NY
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Zip | 14624-5300
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Country | US
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Telephone | 585-889-3280
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Fax |
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Provider Business Mailing Address
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Address Line | 14 ADAIR DR
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City | ROCHESTER
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State | NY
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Zip | 14606-3610
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Country | US
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Telephone | 607-422-9040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 013541
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License Number State | NY
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