Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 11716 | TX |
NPI | 1023320819 |
---|---|
Provider Name | Dr. Shannon Elizabeth Payne |
First Address | San Antonio, TX 78232-5052 |
Second Address | Missouri City, TX 77459-4377 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2010 |
Last Update Date | 13/08/2013 |