Provider Demographics
NPI:1598753402
Name:BARNETT, SHEILA MARIE (RDH, DC)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:MARIE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:RDH, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 MIRACLE MILE
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-3718
Mailing Address - Country:US
Mailing Address - Phone:928-758-4101
Mailing Address - Fax:
Practice Address - Street 1:2775 MIRACLE MILE STE 1
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-3719
Practice Address - Country:US
Practice Address - Phone:928-758-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009042111N00000X
NY018540124Q00000X
AZ8576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB2367Medicare PIN