Provider Demographics
NPI:1639342173
Name:DORAN, SHAE A (DC, CACCP)
Entity Type:Individual
Prefix:
First Name:SHAE
Middle Name:A
Last Name:DORAN
Suffix:
Gender:F
Credentials:DC, CACCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5583 W WATERFORD LN
Mailing Address - Street 2:STE B
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913
Mailing Address - Country:US
Mailing Address - Phone:920-419-1457
Mailing Address - Fax:920-243-0241
Practice Address - Street 1:5583 W WATERFORD LN
Practice Address - Street 2:STE B
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913
Practice Address - Country:US
Practice Address - Phone:920-419-1457
Practice Address - Fax:920-243-0241
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4205-012111NN1001X, 111N00000X
WI4205-12111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor