Provider Demographics
NPI:1598797698
Name:SHEA, DEBORAH ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANN
Last Name:SHEA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:SHEA
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:706 FOREST AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-4283
Mailing Address - Country:US
Mailing Address - Phone:831-649-1711
Mailing Address - Fax:831-649-3063
Practice Address - Street 1:706 FOREST AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-4283
Practice Address - Country:US
Practice Address - Phone:831-649-1711
Practice Address - Fax:831-649-3063
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA016056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0160560Medicare ID - Type Unspecified
CAT06000Medicare UPIN