Provider Demographics
NPI:1083080790
Name:SHEEHAN, BENJAMIN SANFORD (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:SANFORD
Last Name:SHEEHAN
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 1:12020 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-8623
Mailing Address - Country:US
Mailing Address - Phone:409-599-9697
Mailing Address - Fax:
Practice Address - Street 1:3027 MARINA BAY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2729
Practice Address - Country:US
Practice Address - Phone:409-599-9697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor