Provider Demographics
NPI:1053489773
Name:LEVIN, SHARON RUTH (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:RUTH
Last Name:LEVIN
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 1:4144 COUNTY ROAD 101
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-1727
Mailing Address - Country:US
Mailing Address - Phone:952-474-1777
Mailing Address - Fax:
Practice Address - Street 1:4144 COUNTY ROAD 101
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-1727
Practice Address - Country:US
Practice Address - Phone:952-474-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN02D00LEOtherBCBS
MN588366100Medicaid
MN588366100Medicaid
MN02D00LEOtherBCBS