Provider Demographics
NPI:1205842267
Name:SHERADIN, DANIEL ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:SHERADIN
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 1:210 FIELDALE RD
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9177
Mailing Address - Country:US
Mailing Address - Phone:919-563-6370
Mailing Address - Fax:919-563-6371
Practice Address - Street 1:210 FIELDALE RD
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9177
Practice Address - Country:US
Practice Address - Phone:919-563-6370
Practice Address - Fax:919-563-6371
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085KPOtherBCBS
NC2222016OtherFIRST HEALTH
NC648026OtherAMERICAN CHIROPRACTIC NET
NCU93389Medicare UPIN
NCU93389Medicare UPIN
NC2455824Medicare ID - Type Unspecified