Provider Demographics
NPI:1225068745
Name:SHEA, CHERYL (DC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SHEA
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 1:10807 BIG BEND RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6029
Mailing Address - Country:US
Mailing Address - Phone:314-822-7900
Mailing Address - Fax:
Practice Address - Street 1:10807 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6029
Practice Address - Country:US
Practice Address - Phone:314-822-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004004115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V00028Medicare UPIN