Provider Demographics
NPI:1548358450
Name:WOODWARD, SHANNON CODY (DC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:CODY
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3359 MIDDLE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3402
Mailing Address - Country:US
Mailing Address - Phone:563-332-2211
Mailing Address - Fax:563-332-2210
Practice Address - Street 1:3359 MIDDLE RD STE 1
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3402
Practice Address - Country:US
Practice Address - Phone:563-332-2211
Practice Address - Fax:563-332-2210
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28081OtherBLUE CROSS BLUE SHIELD
IAI19359Medicare PIN