Provider Demographics
NPI:1417154519
Name:SHEEHAN, EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SHEEHAN
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 1:29 HORSESHOE LN
Mailing Address - Street 2:
Mailing Address - City:N FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556-3021
Mailing Address - Country:US
Mailing Address - Phone:508-540-6720
Mailing Address - Fax:
Practice Address - Street 1:833 ROUTE 28
Practice Address - Street 2:
Practice Address - City:S YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-5254
Practice Address - Country:US
Practice Address - Phone:508-394-1353
Practice Address - Fax:508-398-2866
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT58241Medicare UPIN