Provider Demographics
NPI:1639568405
Name:STARK, SHEA (DC)
Entity Type:Individual
Prefix:DR
First Name:SHEA
Middle Name:
Last Name:STARK
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 1:8757 JACKRABBIT LN
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-7900
Mailing Address - Country:US
Mailing Address - Phone:406-388-9915
Mailing Address - Fax:406-388-9916
Practice Address - Street 1:8757 JACKRABBIT LN
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-7900
Practice Address - Country:US
Practice Address - Phone:406-388-9915
Practice Address - Fax:406-388-9916
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-3454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor