Individual
DR. SHANNON MARIE BRODERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
74-5620 PALANI RD, SUITE 102, KAILUA KONA, HI 96740-3640
(808) 329-7797
(808) 329-2748
Mailing address
74-5620 PALANI RD, SUITE 102, KAILUA KONA, HI 96740-3640
(808) 329-7797
(808) 329-2748
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC977
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
244327
HMSA NUMBER
HI
01
—
H56328
P-TAN
HI
Enumeration date
12/18/2006
Last updated
06/15/2023
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