| NPI | 1235306119 |
|---|---|
| Former Name | SHANNON MODDEJONGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002519A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10800) |
| 111N00000X Chiropractor (Licence: OH 3943) | |
| Enumeration Date | 2008-05-10 |
| Last Update Date | 2011-07-29 |