Provider Demographics
NPI:1619099611
Name:SHEEHAN, MATTHEW (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
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 1:832 E MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7153
Mailing Address - Country:US
Mailing Address - Phone:541-773-1320
Mailing Address - Fax:
Practice Address - Street 1:832 E MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7153
Practice Address - Country:US
Practice Address - Phone:541-773-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR051990Medicaid
OR051990Medicaid
ORT92723Medicare UPIN