Provider Demographics
NPI:1083701510
Name:SHEA, MITCHELL P (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:P
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 1:750 E SPRING ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4527
Mailing Address - Country:US
Mailing Address - Phone:931-526-4084
Mailing Address - Fax:931-526-6801
Practice Address - Street 1:750 E SPRING ST
Practice Address - Street 2:SUITE D
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4527
Practice Address - Country:US
Practice Address - Phone:931-526-4084
Practice Address - Fax:931-526-6801
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC000822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8037830OtherCIGNA HEALTHCARE
TN0171110OtherBCBS
TN641634OtherACN
TN440236OtherUNITED HEALTHCARE
TN350043697OtherUNITED HEALTHCARE
TN3676558Medicaid
TN0005106212OtherAETNA
TN0005106212OtherAETNA
TN350043697OtherUNITED HEALTHCARE