Provider Demographics
NPI:1821002148
Name:MIROVICH, SHARON ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ANN
Last Name:MIROVICH
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 1:313 LUNENBURG ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4503
Mailing Address - Country:US
Mailing Address - Phone:978-342-9900
Mailing Address - Fax:978-348-2145
Practice Address - Street 1:313 LUNENBURG ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4503
Practice Address - Country:US
Practice Address - Phone:978-342-9900
Practice Address - Fax:978-348-2145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45187Medicare ID - Type Unspecified
MAU71761Medicare UPIN