MEDICARE: SHANNON BRAYER

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	3152	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9119098823A11	OTHER	ANTHEM BC/BS
3	7629359	OTHER	AETNA
4	2802952	OTHER	AETNA SELECT
5	2054628	OTHER	UNITED HEALTHCARE
6	7241987	OTHER	CIGNA 3

General Provider Information

NPI Number	:	1811993975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON BRAYER

Provider Business Mailing Address
First Line	:	203 E ROYALTON RD
Second Line	:	STE 108
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-4038
Country	:	US
Telephone Number	:	440-526-4940
Fax Number	:	440-526-4885

Provider Business Practice Location Address
First Line	:	203 E ROYALTON RD
Second Line	:	STE 108
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-4038
Country	:	US
Telephone Number	:	440-526-4940
Fax Number	:	440-526-4885

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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Directions to “ SHANNON BRAYER ” Practice Location

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