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NPI Code Detail

MEDICARE: DR. SHANNON DEE GAERTNER-EWING DC

MEDICARE: DR. SHANNON DEE GAERTNER-EWING DC
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
1111NN1001XNutrition ChiropractorCHIA829ID

General Provider Information

NPI Number : 1093718702
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANNON DEE GAERTNER-EWING DC
Provider Business Mailing Address
First Line : PO BOX 3306
Second Line :
City : NAMPA
State : ID
Zip : 83653-3306
Country : US
Telephone Number : 208-467-5994
Fax Number : 208-467-5127
Provider Business Practice Location Address
First Line : 217 W GEORGIA AVE STE 120
Second Line :
City : NAMPA
State : ID
Zip : 83686-6812
Country : US
Telephone Number : 208-467-5994
Fax Number : 208-467-5127
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 03/22/2023

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Directions to “ DR. SHANNON DEE GAERTNER-EWING DC” Practice Location

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