MEDICARE: SHANNON MYERS DC LLC

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		TN

General Provider Information

NPI Number	:	1407012495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANNON MYERS DC LLC

Provider Business Mailing Address
First Line	:	111 BROYLES ST
Second Line	:	SUITE 6
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2532
Country	:	US
Telephone Number	:	423-610-0005
Fax Number	:	423-610-0009

Provider Business Practice Location Address
First Line	:	111 BROYLES ST
Second Line	:	SUITE 6
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2532
Country	:	US
Telephone Number	:	423-610-0005
Fax Number	:	423-610-0009

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SHANNON W MYERS
Credential	:	DC
Telephone Number	:	423-610-0005

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	06/19/2013

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