Provider Demographics
NPI:1629149570
Name:SHEPHERD, ERIN A (DC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:A
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2841
Mailing Address - Country:US
Mailing Address - Phone:860-871-0451
Mailing Address - Fax:860-875-3445
Practice Address - Street 1:68 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2841
Practice Address - Country:US
Practice Address - Phone:860-871-0451
Practice Address - Fax:860-875-3445
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350001157Medicare ID - Type Unspecified
U87624Medicare UPIN