MEDICARE: SHANNON WADE MYERS 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	2000	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4091317	OTHER	TN	BLUE CROSS BLUE SHIELD
2	1407012495	OTHER	TN	GROUP NPI
3	1982622601	OTHER	TN	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1982622601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON WADE MYERS D.C.

Provider Business Mailing Address
First Line	:	2101 CHEROKEE RD
Second Line	:	12
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-3473
Country	:	US
Telephone Number	:
Fax Number	:

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	02/04/2020

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Directions to “ SHANNON WADE MYERS D.C.” Practice Location

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