Individual
SHANNON WADE MYERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
111 BROYLES ST, SUITE 6, JOHNSON CITY, TN 37601-2532
(423) 610-0005
(423) 610-0009
Mailing address
2101 CHEROKEE RD, 12, JOHNSON CITY, TN 37604-3473
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2000
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407012495
GROUP NPI
TN
01
—
1982622601
INDIVIDUAL NPI
TN
01
—
4091317
BLUE CROSS BLUE SHIELD
TN
Enumeration date
07/18/2006
Last updated
02/04/2020
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