Provider Demographics
NPI:1114197233
Name:DR. SHEPARD - MEHAFFEY, LLC
Entity Type:Organization
Organization Name:DR. SHEPARD - MEHAFFEY, LLC
Other - Org Name:LAKEWOOD BACK & NECK CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHAFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-238-6500
Mailing Address - Street 1:7400 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5701
Mailing Address - Country:US
Mailing Address - Phone:303-238-6500
Mailing Address - Fax:
Practice Address - Street 1:7400 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5701
Practice Address - Country:US
Practice Address - Phone:303-238-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC550578Medicare PIN