Provider Demographics
NPI:1861490229
Name:BURNS, SHANNON ARLON (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ARLON
Last Name:BURNS
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 1:17842 IRVINE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3203
Mailing Address - Country:US
Mailing Address - Phone:949-651-0044
Mailing Address - Fax:949-651-0012
Practice Address - Street 1:17842 IRVINE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3203
Practice Address - Country:US
Practice Address - Phone:949-651-0044
Practice Address - Fax:949-651-0012
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15050111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15150AMedicare PIN