MEDICARE: MRS. KARA NICHOLE SHANNON 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	072769	IA

General Provider Information

NPI Number	:	1083031702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARA NICHOLE SHANNON D.C

Provider Business Mailing Address
First Line	:	PO BOX 327
Second Line	:
City	:	BUFFALO
State	:	IA
Zip	:	52728-0327
Country	:	US
Telephone Number	:	563-823-8836
Fax Number	:	563-823-8305

Provider Business Practice Location Address
First Line	:	1134 FRONT ST
Second Line	:	SUITE 200
City	:	BUFFALO
State	:	IA
Zip	:	52728-7763
Country	:	US
Telephone Number	:	563-823-8836
Fax Number	:	563-823-8305

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

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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