Provider Demographics
NPI:1700062882
Name:SHANNON, CRAIG ARTHUR (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ARTHUR
Last Name:SHANNON
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 1:14 MANCHESTER SQ STE 120
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7866
Mailing Address - Country:US
Mailing Address - Phone:303-819-8303
Mailing Address - Fax:
Practice Address - Street 1:14 MANCHESTER SQ STE 120
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7866
Practice Address - Country:US
Practice Address - Phone:303-819-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5561111N00000X
NH886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO527748Medicare PIN
CO505498Medicare UPIN