MEDICARE: DR. SHAUNA K. MATHIS 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	1371	LA

General Provider Information

NPI Number	:	1831225150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAUNA K. MATHIS D.C.

Provider Business Mailing Address
First Line	:	221 SAINT ANN DR
Second Line	:	SUITE 2
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3219
Country	:	US
Telephone Number	:	985-624-2250
Fax Number	:	985-624-2572

Provider Business Practice Location Address
First Line	:	221 SAINT ANN DR
Second Line	:	SUITE 2
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3219
Country	:	US
Telephone Number	:	985-624-2250
Fax Number	:	985-624-2572

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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