Individual
SHAWN D WANDERAAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1134 CHURCH ROAD, SOUTHAVEN, MS 38671
(662) 393-4848
Mailing address
1134 CHURCH ROAD W, SOUTHAVEN, MS 38671
(662) 393-4848
(662) 393-4858
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1201
MS
Other
Enumeration date
05/17/2010
Last updated
03/05/2013
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