MEDICARE: SHANNON PEARCE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5317	KY

General Provider Information

NPI Number	:	1063782613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON PEARCE D.C.

Provider Business Mailing Address
First Line	:	3650 BOSTON RD
Second Line	:	STE 188
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1502
Country	:	US
Telephone Number	:	925-487-0253
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 BOSTON RD
Second Line	:	SUITE E
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1569
Country	:	US
Telephone Number	:	925-487-0253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/17/2017

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