Provider Demographics
NPI:1639592793
Name:HEGARTY, SHANNON (DC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HEGARTY
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 1:83 GREAT RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5682
Mailing Address - Country:US
Mailing Address - Phone:202-302-3514
Mailing Address - Fax:
Practice Address - Street 1:83 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5682
Practice Address - Country:US
Practice Address - Phone:202-302-3514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor