Provider Demographics
NPI:1689242703
Name:SHEEHAN, BROOK (DC)
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:
Last Name:SHEEHAN
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 1:708 MUNEVAR RD
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1331
Mailing Address - Country:US
Mailing Address - Phone:619-876-7584
Mailing Address - Fax:
Practice Address - Street 1:224 BIRMINGHAM DR STE 1A1
Practice Address - Street 2:
Practice Address - City:CARDIFF BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:92007-1743
Practice Address - Country:US
Practice Address - Phone:619-876-7584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor