Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR009870 | GA |
N | 111NP0017X | Pediatric Chiropractor | CHIR009870 | GA |
NPI | 1952838476 |
---|---|
Provider Name | Dr. Shannon Joye O'brien |
First Address | Kennesaw, GA 30144-1354 |
Second Address | Kennesaw, GA 30144-1354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2017 |
Last Update Date | 15/05/2017 |