| Shannon Chiropractic Wellness Llc | |
|
397 Kenwood Ave Delmar NY 12054-3248 | |
| (518) 439-1916 | |
| Not Available |
| Full Name | Shannon Chiropractic Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 397 Kenwood Ave, Delmar, New York |
| Authorized Official Name and Position | Roger Philip Shannon (OWNER) |
| Authorized Official Contact | 5184391916 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shannon Chiropractic Wellness Llc 397 Kenwood Ave Delmar NY 12054-3248 Ph: (518) 439-1916 | Shannon Chiropractic Wellness Llc 397 Kenwood Ave Delmar NY 12054-3248 Ph: (518) 439-1916 |
| NPI Number | 1649568734 |
|---|---|
| Provider Enumeration Date | 07/11/2011 |
| Last Update Date | 07/11/2011 |
| Medicare PECOS PAC ID | 7618147414 |
|---|---|
| Medicare Enrollment ID | O20110906000439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649568734 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 011939 (New York) | Primary |
| Provider Name | Roger Philip Shannon |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1760784045 PECOS PAC ID: 8527238328 Enrollment ID: I20110906000542 |
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