Provider Demographics
NPI:1366540577
Name:POMEROY, SHAWN (DC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:POMEROY
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 1:6254 E 37TH ST N
Mailing Address - Street 2:SUITE #110
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67220-1997
Mailing Address - Country:US
Mailing Address - Phone:316-686-2020
Mailing Address - Fax:316-691-9859
Practice Address - Street 1:6254 E 37TH ST N
Practice Address - Street 2:SUITE #110
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67220-1997
Practice Address - Country:US
Practice Address - Phone:316-686-2020
Practice Address - Fax:316-691-9859
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS62123OtherBCBS NUMBER
KS62123OtherBCBS NUMBER
KS062123Medicare ID - Type Unspecified