Provider Demographics
NPI:1386653673
Name:FLEHARTY, SHANE J (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:J
Last Name:FLEHARTY
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 1:2125 WINTHROP RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-4156
Mailing Address - Country:US
Mailing Address - Phone:402-483-2544
Mailing Address - Fax:402-483-2548
Practice Address - Street 1:2125 WINTHROP RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-4156
Practice Address - Country:US
Practice Address - Phone:402-483-2544
Practice Address - Fax:402-483-2548
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084162100Medicaid
NE274173Medicare ID - Type Unspecified