# DR. SHANNON MARIE BRODERSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1194888552
- **Gender:** F
- **Credential:** D.C.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | DC977 | HI | Yes |

## Other

- **Enumeration date:** 12/18/2006
- **Last updated:** 06/15/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 244327 | HMSA NUMBER | HI |
| 01 | — | H56328 | P-TAN | HI |