Provider Demographics
NPI:1851508212
Name:SHEA, PATRICIA (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:SHEA
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 1:542 OCEAN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6622
Mailing Address - Country:US
Mailing Address - Phone:831-425-4525
Mailing Address - Fax:831-425-1701
Practice Address - Street 1:542 OCEAN ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-6622
Practice Address - Country:US
Practice Address - Phone:831-425-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor