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General NPI Number Information
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NPI Number | 1972833119
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Entity Type | Organization
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Legal Business Name | SHANAHAN CHIROPRACTIC LLC
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 16795 COUNTY ROAD 24 SUITE 120
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City | PLYMOUTH
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State | MN
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Zip | 55447-1201
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Country | US
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Telephone | 651-491-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 16795 COUNTY ROAD 24 SUITE 120
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City | PLYMOUTH
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State | MN
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Zip | 55447-1201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. REESE ROBERT SHANAHAN
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Credential | D.C
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Telephone | 651-491-0111
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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 | 5329
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License Number State | MN
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