Provider Demographics
NPI:1033361092
Name:SHEA, DEVIN MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:MATTHEW
Last Name:SHEA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13526 POWAY RD.
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064
Mailing Address - Country:US
Mailing Address - Phone:858-668-1700
Mailing Address - Fax:858-513-4614
Practice Address - Street 1:13526 POWAY RD.
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:858-668-1700
Practice Address - Fax:858-513-4614
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31049111N00000X
CA31049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAZ345Medicare UPIN