Provider Demographics
NPI:1104035773
Name:BEARDO, SHEILA MARIE (DC)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:BEARDO
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 1:3171 GLENDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1805
Mailing Address - Country:US
Mailing Address - Phone:323-663-9670
Mailing Address - Fax:323-663-1556
Practice Address - Street 1:3171 GLENDALE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1805
Practice Address - Country:US
Practice Address - Phone:323-663-9670
Practice Address - Fax:323-663-1556
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15784111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation