Provider Demographics
NPI:1043216492
Name:SHEA, LEANN M (DC)
Entity Type:Individual
Prefix:DR
First Name:LEANN
Middle Name:M
Last Name:SHEA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 1/2 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3606
Mailing Address - Country:US
Mailing Address - Phone:507-625-4822
Mailing Address - Fax:
Practice Address - Street 1:217 1/2 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3606
Practice Address - Country:US
Practice Address - Phone:507-625-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN066527400Medicaid
MN350049793OtherRAILROAD MEDICARE ID NUMB
MN3M150SHOtherBCBSM INDIVIDUAL ID NUMBE
MN39673SHOtherBCBSM PRACTICE ID NUMBER
MN359000300Medicare ID - Type UnspecifiedWPS -MEDICARE ID NUMBER
MN3M150SHOtherBCBSM INDIVIDUAL ID NUMBE