Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician | ||
Y | 111N00000X | Chiropractor | 13813 | TX |
NPI | 1003354960 |
---|---|
Provider Name | Shannon Kirkwood |
First Address | Spring Branch, TX 78070-7116 |
Second Address | Spring Branch, TX 78070-7116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2017 |
Last Update Date | 09/10/2018 |