MEDICARE: SHANNAHAN CHIROPRACTIC, INC.

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	DC 24900	CA

General Provider Information

NPI Number	:	1881814077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANNAHAN CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	1764 SAN DIEGO AVE STE 140
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1987
Country	:	US
Telephone Number	:	619-543-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1764 SAN DIEGO AVE STE 140
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1987
Country	:	US
Telephone Number	:	619-543-9999
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TIMOTHY EVANS SHANNAHAN
Credential	:	D.C.
Telephone Number	:	619-543-9999

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	09/29/2015

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Directions to “SHANNAHAN CHIROPRACTIC, INC. ” Practice Location

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