Provider Demographics
NPI:1750367793
Name:CHRIVIA, SHANNON KAY (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KAY
Last Name:CHRIVIA
Suffix:
Gender:F
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:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:HALE
Mailing Address - State:MI
Mailing Address - Zip Code:48739-0142
Mailing Address - Country:US
Mailing Address - Phone:989-728-6638
Mailing Address - Fax:989-728-6637
Practice Address - Street 1:3141 M 65
Practice Address - Street 2:
Practice Address - City:HALE
Practice Address - State:MI
Practice Address - Zip Code:48739-8512
Practice Address - Country:US
Practice Address - Phone:989-728-6638
Practice Address - Fax:989-728-6637
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4345464Medicaid
MI4345464Medicaid
MIU74096Medicare UPIN