Provider Demographics
NPI:1255310025
Name:SHEA CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:SHEA CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-733-0778
Mailing Address - Street 1:230 FOREST PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2034
Mailing Address - Country:US
Mailing Address - Phone:413-733-0778
Mailing Address - Fax:413-746-9077
Practice Address - Street 1:230 FOREST PARK AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2034
Practice Address - Country:US
Practice Address - Phone:413-733-0778
Practice Address - Fax:413-746-9077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY49089Medicare PIN