Provider Demographics
NPI:1114517950
Name:SHEA, SEAN THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS
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 1:551 NEW ALEXANDRIA RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-1444
Mailing Address - Country:US
Mailing Address - Phone:518-578-5568
Mailing Address - Fax:
Practice Address - Street 1:11581 PENNSYLVANIA AVE # 98
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-6247
Practice Address - Country:US
Practice Address - Phone:814-336-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor