Provider Demographics
NPI:1043653652
Name:BONCZYK, SHANNON LEE (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEE
Last Name:BONCZYK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7133 W MAIN RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-9380
Mailing Address - Country:US
Mailing Address - Phone:585-639-4652
Mailing Address - Fax:585-510-4527
Practice Address - Street 1:7133 W MAIN RD STE 1
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-9380
Practice Address - Country:US
Practice Address - Phone:585-813-5157
Practice Address - Fax:585-510-4527
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor